Case history
Case history #1
A 40-year-old woman presents with polyarthralgia, fatigue, and weakness. Physical exam is remarkable for lower extremity purpura and lack of objective signs of synovitis. Laboratory workup 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 nonhealing ulcers in the lower extremities. Vascular testing is negative for arterial and venous insufficiency. Skin biopsies are nonspecific. Physical exam reveals bluish discoloration of hands and feet (acrocyanosis) and large lower-extremity nonhealing ulcers. Laboratory workup is remarkable for a normocytic normochromic anemia, elevated erythrocyte sedimentation rate, and mild renal impairment.
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