36-Year-Old Woman With Raynaud, Facial Paresthesia, and Rash

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A kidney biopsy is ordered after a 36-year-old woman initially diagnosed with isolated Raynaud phenomenon reports a series of new symptoms: arthralgia, facial paresthesia, then a photosenstive rash. The problem may not match your first guess.

Three years after diagnosis and successful treatment for isolated Raynaud phenomenon, a 36-year-old woman was found on random urinalysis to have isolated 2+ proteinuria.  Although the cause remained unclear, the proteinuria was managed with an ACE inhibitor.

[[{"type":"media","view_mode":"media_crop","fid":"22518","attributes":{"alt":"","class":"media-image media-image-right","id":"media_crop_7363002579298","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"1640","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"float: right; margin: 10px 5px; width: 249px; height: 167px;","title":" ","typeof":"foaf:Image"}}]]The patient was found to have hypothyroidism and complained intermittently of facial paresthesia, subsequently diagnosed as trigeminal neuralgia. Then arthralgia developed, predominantly in the right knee. Ultrasound examination showed patchy synovitis of the right knee, with no fluid.

After a fine morbilliform, scattered, nonraised, nonpruritic photosensitive rash developed, beginning on the lower extremities, the patient was scheduled for a renal biopsy. A micrograph from the specimen appears at right. What does it show?

Click here for the full case report and discussion.

 

 

 

 

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