LAUSR

A 65-year-old woman presented to the emergency department with a 14-day history of pain in her right arm and painful cutaneous lesions on her right hand palm. Four days previously, she had undergone a coronary angiography for Takotsubo syndrome. She had a history of smoking, arterial hypertension and dyslipidaemia. Physical examination revealed painful and erythematous pustular papulovesicles with hardened surrounding skin on the palm and fingertips of the patient’s right hand (Fig. 1a). Ipsilaterally, she had a purpuric lesion on the third finger subungual apparatus (Fig. 1b). No other cutaneous lesions were observed. Blood pressure was very high at 190/87 mmHg. Blood and urine tests including renal and liver function, C-reactive protein, complete blood count, Ddimer, coagulation and urine sediment, were all normal. Chest radiography, Doppler ultrasonography of the right arm and echocardiography, were also normal. Computed tomography angiography of the aorta and both arms revealed atheromatosis of the coronary arteries without signs of distal embolism. A biopsy was taken from one of the lesions on the palm. Histopathological findings