Angiosarcoma presenting as unexplainable unilateral leg pain and purpuric toes

An older man presented with increasing pain the in right leg over 3 months, with no relief after femoral artery stenting. He was non‐diabetic and had a normal nerve conduction study. He developed transient tender purpura on the right anterior thigh, then purple‐black nodules isolated to his toes (Figure, A). He had a strongly positive Ro52 titre, suggesting an underlying immunogenic process (autoimmune, infection, neoplastic).1,2 Fluorodeoxyglucose (FDG)‐positron emission tomography (PET)/computed tomography scan revealed innumerable FDG‐avid lesions in the subcutaneous tissues, muscles and bones of the right lower limb, and a focal serosal deposit (Figure, B). Only the toe lesions were appreciated clinically (Figure, B, green arrow). The image shows a focus of left lateralised abdominal activity, possibly representing a small bowel serosal deposit (Figure, B, red arrow). Skin biopsy of a toe lesion revealed angiosarcoma.