An 82-year-old woman with new onset of multiple purple-reddish nodules during treatment with abatacept for rheumatoid arthritis

Dr. Ambrogio: Our case is that of an 82-year-old female patient. In 2015, she developed inflammation affecting knees, ankles, wrists, and proximal interphalangeal joints. Consequently, she was diagnosed with RA. She was initially treated with methylprednisolone 4 mg/daily and methotrexate 15 mg/week despite low clinical remission. In January 2017, she suspended methotrexate due to radiologic detection of RA-associated interstitial lung disease. Therefore, she undertook therapy with azathioprine 200 mg/daily and then with salazopirine 1000 mg/daily. However, both drugs were interrupted because of adverse events. Thus, in September 2017 she started abatacept 125 mg/week in association with prednisone 5 mg/daily obtaining a signif cant clinical amelioration. Prof. Foti: However, in February 2020, she came to our observation due to the appearance of multiple purple-reddish nodules on the left leg (Fig. 1) and a hemorrhagic-crusted nodular lesion in the left sural area. The clinical diagnosis of KS was proposed.