Our initial physical examination revealed a frail man appearing older than his age, who ambulated with an unsteady gait requiring the assistance of a walker. Cutaneous examination revealed firm, flesh-colored to deeply erythematous papules and nodules on his hands, fingers, ears, nares (acral distribution), and oral mucosa, and small papules overlying a poikilodermatous patch on his right chest (Figure 2). Tender inflammation and limited range of motion of his knees, ankles, shoulders, wrists, and hands were prominent. Several fingers displayed moderate contracture deformity. He provided photographs of the arthroscopic examination of his right knee (Figure 3). Histopathologic evaluation of both a papule and portion of the patch from his right chest revealed dermal infiltration with multinucleated giant cells with an amorphous, eosinophilic, “ground-glass”–appearing cytoplasm, varying only in density of infiltration (Figure 4). Laboratory evaluation revealed an elevated creatine kinase level of 350 U/L (reference range, 24-204 U/L) (to convert to microkatals per liter, multiply by 0.0167), a C-reactive protein level of 21.9 mg/L (reference range, 0-4.9 mg/L) (to convert to nanomoles per liter, multiply by 9.524), and an erythrocyte sedimentation rate or 21 mm/h (reference range, 0-20 mm/h). Results from the following evaluations were negative or normal: complete blood cell count, comprehensive metabolic panel, thyroid panel, serum protein electrophoresis, serum immunofixation electrophoresis, antineutrophilic cytoplasmic antibody, anticardiolipin antibody, β-2 glycoprotein 1 antibody, rheumatoid factor, antinuclear antibody, anti–double-stranded DNA antibody, and hepatitis C antibody.