PRESENTING FEATURES: A 52-year-old woman with a history of diabetes, hypertension, end-stage renal disease,
hepatitis C, and peripheral vascular disease presented with a painful, black skin
lesion on her left calf. The lesion had appeared 1 month before admission when she
noted redness of the skin; in the interim, the lesion became progressively darker
and more painful. There were also reddened areas on her thighs and breast, but they
were not as painful. There was no history of recent trauma to the area, drainage or
bleeding from the lesion, fevers, chills, or other systemic symptoms. She was undergoing
hemodialysis three times weekly. Past medical history also included an amputation
below the right knee for vascular insufficiency. She was taking nifedipine, metoprolol,
insulin, erythropoietin, folic acid, multivitamins, and calcium carbonate.
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