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Purple Toes in a Patient With End-Stage Rheumatoid Arthritis
Hossein C. Nousari, MD;
Arash Kimyai-Asadi, MD;
Justin Stebbing, MD, MRCP;
John H. Stone, MD, MPH
Arch Dermatol. 1999;135:648-650.
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REPORT OF A CASE
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.
The patient's medical history was significant for deforming rheumatoid arthritis (RA) of 30 year's duration, meeting the American College of Rheumatology criteria for RA. She had been treated with tapering courses of prednisone starting at a dose of 60 mg/d, weekly . . . [Full Text of this Article]
COMMENT
From the Division of Dermatoimmunology, Department of Dermatology (Drs Nousari and Kimyai-Asadi), and the Division of Rheumatology, Department of Medicine (Drs Stebbing and Stone), Johns Hopkins Medical Institutions, Baltimore, Md
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