Case history
Case history #1
A 40-year-old woman presents with polyarthralgia, fatigue, and weakness. Physical examination is remarkable for lower extremity purpura and lack of objective signs of synovitis. Laboratory work-up reveals mild elevation of transaminases, positive rheumatoid factor, and a low positive antinuclear antibody. Skin biopsy reveals leukocytoclastic vasculitis. Subsequent testing shows positive hepatitis C virus antibody, with polymerase chain reaction confirming active replication.
Case history #2
A 65-year-old man presents with a 6-month history of non-healing ulcers in the lower extremities. Vascular testing is negative for arterial and venous insufficiency. Skin biopsies are non-specific. Physical examination reveals bluish discoloration of hands and feet (acrocyanosis) and large lower-extremity non-healing ulcers. Laboratory work-up is remarkable for a normocytic normochromic anaemia, elevated erythrocyte sedimentation rate, and mild renal impairment.
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