Case Presentation A 43-year-old woman presented to the emergency department with painful discoloration of both great toes, initially involving the left hallux and subsequently the right. The discoloration progressed over several days and was associated with swelling and increasing pain. Symptoms began shortly after a pedicure performed two to three weeks prior to presentation.
She denied claudication, rest pain prior to this episode, Raynaud’s phenomenon, dysphagia, proximal muscle weakness, photosensitive rash, arthralgia, or skin thickening. Past Medical History Single episode of acute pancreatitis in 2006 No known autoimmune disease No known chronic kidney disease Weight and Constitutional Symptoms The patient reported significant unintentional weight loss of approximately 80 kg over three years. She denied fever, night sweats, gastrointestinal symptoms, respiratory complaints,…
