A 52-year-old woman with RA presented with a 1-month history of multiple painful, erythematous plaques on her palms and the fingers. One and a half years ago, she was treated with etanercept for 6 months. She has been on maintenance medication sulfasalazine and azathioprine for the last 3 years. Examination Along with her skin lesions, her palms and fingers indicated ulnar deviation and Z deformity of both hands- typical chronic changes due to RA. The patient was afebrile.
ESR was 50mm/hour (normal value <15), CRP: 20.2mg/L (normal value <3.5), WBC: 3670/mm 3 with 875 neutrophils. A skin biopsy revealed dermal edema and perivascular and interstitial lymphohistiocytic and neutrophilic infiltration. What is the most likely diagnosis? *This case is from Docplexus editorial team for educative purpose only. Source: NEJM Stay Connected, the answer will be posted in the next 48h!
