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February 21, 2011

Serpiginous Erythematous Plaques on the Feet—Quiz Case

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Arch Dermatol. 2011;147(2):235-240. doi:10.1001/archdermatol.2010.425-a

A 55-year-old woman presented to our dermatology department with a 10-year history of recurrent pruritic and painful papules, vesicles, and pustules on the plantar and lateral surfaces of her feet. She had a history of Sjögren syndrome (SS) with sicca symptoms complicated by type II mixed cryoglobulinemia and intermittent episodes of palpable purpura on the lower legs. The patient noted periodicflares of scaly erythema of her feet that correlated with exacerbations of SS. Physical examination demonstrated sharply circumscribed, erythematous plaques with serpiginous borders involving the dorsal and lateral feet (Figure 1 and Figure 2). Results from a potassium hydroxide examination were negative for fungal infection. Her antinuclear antibody test was positive at a 1:320 dilution with a speckled pattern, and tests for anti-Ro/SSA and anti-La/SSB auto-antibodies were positive. Serum protein electrophoresis showed a band consistent with a monoclonal protein M spike. Tests for hepatitis C antibodies were negative. Immunofixation of the cryoprecipitate shows a monoclonal IgM and polyclonal IgG consistent with mixed type II cryoglobulinemia. A skin biopsy of the scaly erythematous plaque on the left lateral ankle was performed (Figure 3).

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