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

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.

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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.