Dr. John Arradondo, Junior Assistant Resident in Medicine, Jewish Hospital of St. Louis, and Assistant in Medicine, Washington University School of Medicine: This is the third admission of a 61-yearold white woman florist with peripheral vascular disease and persistent and recurrent leg ulcers. The patient was admitted at this time for evaluation and possible correction of the peripheral arterial insufficiency.
Three years ago the patient was found to have cutaneous ulcerations over the left ankle which healed with antibiotics. For several years, however, she had had generalized and recurrent small cutaneous nodules that occasionally ulcerated but always healed. Those nodules were frequently arrayed along the lymphatic pathways, but were not associated with edema. In the past two years the patient has had mild night sweats, increased fatigue with a variable, productive cough, and a 11.3-kg (25-lb) weight loss. There was no hemoptysis, fever, dyspnea, or edema. About a year prior