A 41-year-old white man presented with a 7-year history of erythematous papules, livedo reticularis, swelling, myalgias, arthralgias, Raynaud phenomenon, and very large, painful and progressive ulcers on the lower part of both legs (Figure 1). A skin biopsy specimen revealed polyarteritis nodosa (PAN) with fibrinoid necrosis of medium-sized vessels. The patient fulfilled 4 of the criteria for PAN (ie, weight loss >4 kg, livedo reticularis, myalgias, and characteristic histological picture).1 Also, he had an elevated erythrocyte sedimentation rate, leukocyte count (Figure 2), CD3+ cell count (pan-T cells) (3.5 × 109/L), CD3+CD4+ T-cell count (T-helper cells) (2.7 × 109/L), and antinuclear antibody titer (1:640, speckled pattern). Systemic prednisone therapy administered at dosages as high as 100 mg/d had little, if any, effect. The patient's intense pain could only be controlled with morphine derivatives.