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JAMA Dermatology Clinicopathological Challenge
October 2016

Ulcers of the Ventral Aspect of Fingers

Author Affiliations
  • 1Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia
  • 2Department of Rheumatology, University of Pennsylvania Perelman School of Medicine, Philadelphia
JAMA Dermatol. 2016;152(10):1157-1158. doi:10.1001/jamadermatol.2016.2748

A 42-year-old African American male presented with a 7-month history of fatigue, exertional dyspnea, arthralgias, hand swelling, tender ulcerations, hair loss, and a 50-pound weight loss. He had been hospitalized 6 months prior for hypoxia. Chest computed tomography (CT) showed hilar lymphadenopathy, interstitial thickening, and perilymphatic ground glass opacities. Bronchoscopy revealed plaquelike lesions, and transbronchial nodal aspiration of mediastinal nodes was negative for carcinomas and/or granulomas. Prednisone was initiated for presumed sarcoidosis. Antineutrophil cytoplasmic antibodies, antinuclear antibodies, angiotensin-converting enzyme, rheumatoid factor, and Aspergillosis antigen were negative and/or normal. The patient was referred for a second opinion.