A 34-Year-Old Woman With Knots on Her Leg and Reddening Skin

Padma Chitnavis, MD; Mary Maiberger, MD

Disclosures

September 10, 2019

Editor's Note:
The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.

Background

A 34-year-old woman presents with painful, red "knots" on her right leg that appear to trace along her veins, which started 3-4 days ago (Figure).

Figure.

She denies any trauma, including venipuncture, to this area. She also expresses concern about the general appearance of the skin on her arms, legs, and trunk, which she states has looked "redder" for the last few years.

She has a complicated obstetric history, including one late-term miscarriage at 14 weeks' gestation, treated with dilation and curettage, and a subsequent pregnancy complicated by eclampsia, with the delivery of a healthy baby. She has not been started on any new medications. Her medical history is otherwise notable for a prior diagnosis of syphilis status post-antimicrobial therapy after a positive rapid plasma reagin (RPR) test.

A review of systems is notable for occasional subjective fevers and intermittent abdominal pain without any temporal relation to her meals, in addition to occasional pain and swelling of her knees and wrists. She denies any diarrhea or tarry or bloody stools.

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