A 57-year-old Puerto Rican woman was admitted with a 4-week history of painful, purple toes associated with malaise, fevers, sweats, and intermittent discomfort in the middle part of her chest. She had initially presented to an outside hospital, where blood cultures, a transthoracic echocardiogram, and an angiogram of the lower abdominal aorta with runoff revealed no abnormalities. However, it was concluded that she had had thromboembolic events to her toes, and warfarin therapy was initiated. She presented to our institution 2 weeks later with worsening pain and moderate expansion of the ischemic area.
Nousari HC, Kimyai-Asadi A, Stebbing J, Stone JH. Purple Toes in a Patient With End-Stage Rheumatoid Arthritis. Arch Dermatol. 1999;135(6):648–650. doi:10.1001/archderm.135.6.648