Examination of the patient in April 2021 and in November 2023. (A and B) Photos from April 2021 show (A) right foot purpuric rash and (B) bilateral lower extremity rash below the knees. (C) Photos from November 2023 show (C) left hand rash and finger swelling. (A–C) April 2021 photos of (A) right foot purpuric rash and (B) bilateral lower extremity rash below the knees, and November 2023 photo of (C) left-hand rash and finger swelling.