A 70-year-old woman presented with a 3-week history of pain and redness of her right calf followed by the development of an exquisitely painful, rapidly enlarging ulcer. There was no history of trauma or associated systemic upset. Her medical history was notable for adult polycystic kidney disease requiring hemodialysis after chronic rejection of a cadaveric kidney transplant. A malignant melanoma (Breslow thickness 5.2 mm) had also been excised from the patient's left thigh in June 2003. Her medications included warfarin sodium for previous deep vein thrombosis and pulmonary embolism, prednisolone (10 mg/d), simvastatin (20 mg/d), temazepam (10 mg/d), omeprazole (40 mg/d), and aluminum hydroxide (475 mg 3 times a day).
Chakrabarti S, Williamson D. A Rapidly Enlarging Necrotic Ulcer on the Right Calf—Quiz Case. Arch Dermatol. 2007;143(6):791-796. doi:10.1001/archderm.143.6.791-c