A 27-year-old, human immunodeficiency virus–negative white man with an 8-year history of Wegener granulomatosis underwent a frontal sinus biopsy after severe recurrent nose bleeding. The patient's condition remained stable on a regimen of cyclophosphamide and prednisone for approximately 2 years until laboratory tests revealed that his serum urea nitrogen and creatinine levels were elevated; the results of a renal biopsy confirmed a diagnosis of Wegener granulomatosis. Peritoneal dialysis was subsequently initiated 2 years before the patient presented with a skin eruption. Other significant medical history included arthritis, hypertension, anemia due to chronic renal failure and chronic disease, cytomegalovirus colitis, herpes zoster infection with associated encephalitis, and testicular leiomyoma.
Enelow TJ, Huang W, Williams CM. Perforating Papules in Chronic Renal Failure. Arch Dermatol. 1998;134(1):97-102. doi: