Can you diagnose this 19-year-old with painful purpuric nodules on her fingers?

Welcome to this Contemporary Pediatrics poll. Take a look at the following case below. After reading through the description, choose a multiple-choice answer and try to guess the correct patient diagnosis.

Then visit our website on Wednesday at 12:00 PM ET or later for the full case presentation, differential diagnosis, and correct patient diagnosis.

This case was presented by Isha Sanghani and Bernard A. Cohen, MD.

The Case

A 19-year-old female presented with painful purpuric nodules localized to the distal phalanges of her fingers. It is associated with intermittent swelling, itching, and pain. Three weeks earlier, she had experienced mild upper respiratory symptoms, including nasal congestion and sore throat, which resolved without medical intervention. Shortly thereafter, she learned that a close friend had tested positive for COVID-19 prior to her illness.

On examination, the lesions were erythematous and violaceous, tender to touch, and consistent with chilblain-like lesions. She denied systemic symptoms such as fever or fatigue, and was otherwise healthy.

Below, take your best guess at diagnosing this patient.