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The patient is a 55 y.o. WF, with history of diabetes, hypertension ,coronary artery disease, and end stage renal failure. The patient was on hemodialysis for six years. Several months prior to presentation she started developing painful abdominal lesions. Initial biopsies were not diagnostic. The lesions enlarged, and the patient was admitted for evaluation. and an incisional biopsy was performed.
On physical examination, the patient was a severely ill appearing, obese white female with multiple painful, necrotic, crusted ulcerations with surrounding purpurae,Figs. 1-3 and subcutaneous nodules/cords in the abdominal panus, Fig.4. Her biopsy site had a 12 x 3 cm full thickness (epidermis, dermis, subcutaneous fat) defect with visible necrosed fat.
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