USMLE® Step 1 style questions USMLE
USMLE® Step 2 style questions USMLE
A 33-year-old woman, gravida 0, para 0, comes to the office because of new skin lesions that are tender and painful to touch on her trunk and extremities bilaterally. She has a history of rheumatoid arthritis diagnosed ten years ago, and reports worsening joint pains, intermittent fevers and general malaise. Laboratory analysis is notable for leukocytosis and an elevated erythrocyte sedimentation rate (ESR). Biopsy of one of the lesions shows neutrophilic inflammation without fibrinoid necrosis. Which of the following is the most likely diagnosis?