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The patient was a 15-year-old male adolescent with painful and pruritic erythematous indurated nodules on his legs and hands that progressed to ulcerated lesions over 1 month (figure 1). The patient had medical history of juvenile idiopathic arthritis, hypothyroidism and hyperphosphatemia. He was treated with prednisolone, methotrexate, levothyroxine and sevelamer carbonate.
Laboratory tests (complete blood count, biochemical tests, blood complement level, liver function …
Contributors MS and SH wrote the manuscript in consultation with PS.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.