LAUSR

RODUCTION INT A 23-year-old female presented with painful upper and lower extremity lesions and fatigue. She denied neurologic, pulmonary, cardiac, renal, gastrointestinal, and musculoskeletal symptoms during a review of the systems. Clinical examination revealed bilateral lower extremity tender subcutaneous nodules (Fig 1) and upper extremity livedo racemosa (Fig 2). Punch biopsy revealed a perivascular lymphohistiocytic infiltrate, extravasated red blood cells, and a necrotic blood vessel at the dermal-subcutaneous junction (Fig 3). The vitals were within normal limits, and laboratory investigations, including renal and hepatic function, antinuclear and antineutrophil cytoplasmic antibodies, cryoglobulins, rheumatoid factor, hypercoagulability workup, and angiography, were unremarkable, except for an elevated erythrocyte sedimentation rate.