26 year old female with painful lesions on fingers and toes

    26 year old female referred for a complex 2 year history of painful red bumps on her fingertips and toes following an episode of abdominal pain 2 years ago. The patient reports that the lesions are very sensitive and painful to the touch and that they worsen with exposure to the cold. The patient has been worked up with numerous labs which have all been normal (SPEP neg, CBC, BMP, SSA, SSB, Rf, ANA, CRP, ESR, antiSCL070 Ab). She has been afebrile since her symptoms started. Of note, a biopsy done at an outside hospital showed interface dermatitis with necrotic keratinocytes. The patient has no family history of SLE. The patient is also complaining of visual changes and lightheadedness for which she saw neurology and was diagnosed with hyperintensities of white matter on MRI without stigmata of MS and with unclear significance.