Image of the Week: What condition is contributing to this rare disorder?

A 56-year-old man 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 immunoglobulin G (IgG) and ...