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June 2007

A Rapidly Enlarging Necrotic Ulcer on the Right Calf—Diagnosis

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Arch Dermatol. 2007;143(6):791-796. doi:10.1001/archderm.143.6.791-g

The biopsy specimen demonstrated hemorrhagic infarction of the entire dermis and epidermis. The underlying fatty subcutis showed extensive calcification but no obvious vasculitis or panniculitis (Figure 2). There was also calcification present in association with a venule (Figure 3). A review of blood test results from the preceding 2 years showed high parathyroid hormone levels peaking to 199 mg/dL (21 pmol/L) (RR, 15-66 mg/dL [1.6-6.9 pmol/L]), with an elevated calcium-phosphate product. A radiograph of the lower leg showed extensive vascular calcification, which is common in the lower extremities of patients with end-stage renal failure, however, and is not specific for calciphylaxis. The diagnosis of calciphylaxis was made.

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