Figure 1

Quick Quiz

What condition is most commonly associated with this patient's presentation?

A 56-year-old male with a history of cirrhosis presents with new pigmented papules on his fingers and toes. Over the past month, he has also felt progressive joint pain and weakness. Laboratory tests reveal elevated levels of erythrocyte sedimentation rate, rheumatoid factor, and low complement levels. Further serum testing and protein electrophoresis demonstrates high counts of IgG and IgM. Which of the following conditions is most commonly associated with this patient’s presentation? Image credit: @roverome.