Mottled Skin Changes

Laboratory results included the following: white blood cell count, 10,000 per mm3 (10.0 × 109 per L); hemoglobin, 8.5 g per dL (85 g per L); erythrocyte sedimentation rate, 115 mm per hour (normal, 0 to 30 mm per hour); sodium, 137 mEq per L (137 mmol per L); potassium, 4.4 mEq per L (4.4 mmol per L); blood urea nitrogen, 23 mg per dL (8.2 mmol per L); creatinine, 1.4 mg per dL (124 μmol per L); urinalysis, normal; antinuclear antibody, positive (1:640) with a nucleolar pattern; and rheumatoid factor, 24.6 IU per mL (normal, 0 to 13.9 IU per mL). Pulmonary involvement may include interstitial lung disease and pulmonary artery hypertension.2 Nucleolar pattern antinuclear antibodies are associated with antiribonucleoprotein, which is characteristic of scleroderma and rare in other immune disorders.3 Dermatomyositis often presents as proximal muscle weakness and a heliotrope rash, commonly involving the eyelids.4 Rheumatoid arthritis is typically associated with symmetrical joint involvement, morning stiffness, synovial thickening, and a family history of the disease.2 Systemic lupus erythematosus can manifest in a variety of ways. Dermatologic manifestations include nonpruritic, erythematous to violaceous plaques, often on sun-exposed areas.