Cases from the osler medical service at johns hopkins university

      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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