A 47-year-old white Hispanic man presented with a 1-month history of multiple firm, pink papules over the hands, forearms, face, and ears. There was no associated pruritus, bleeding, or history of known exposures. The onset of lesions was accompanied by unintentional weight loss of 6.8 kg over 4 weeks; arthritis of the hands, elbows, and knees; and recurrent fevers, for which the patient had not yet received medical evaluation or treatment. Physical examination revealed multiple discrete, mildly tender, firm, pink papules over the dorsum of the hands, wrists, forearms, face, and helices, without surrounding erythema, edema, or excoriation (Figure 1). A swollen, erythematous, and warm left elbow was noted, as well as a grossly cachectic appearance and temperature of 38.4°C. A shave biopsy specimen of a papule from the patient's hand was obtained for hematoxylin-eosin staining (Figure 2 and Figure 3), and the patient was admitted for further workup and treatment.