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July 1995

Widespread Livedo Reticularis With Painful Ulcerations

Author Affiliations

USA; USA; USA; USA; USA; Dewitt Army Community Hospital, Fort Belvoir, Va (CPT Young), and Walter Reed Army Medical Center, Washington, DC (MAJ Cuozzo, Dr Seidman, LTC Benson, and COLs Sau and James)

Arch Dermatol. 1995;131(7):786-788. doi:10.1001/archderm.1995.01690190038006

REPORT OF A CASE  A 66-year-old white woman with type II diabetes mellitus requiring insulin and secondary nephrotic syndrome was found to have noncaseating granulomas, consistent with sarcoidosis, on a bone marrow biopsy specimen obtained for an evaluation for anemia. Corticosteroids were subsequently prescribed. Laboratory studies performed at that time disclosed the following values: serum urea nitrogen, 10.7 mmol/L (30 mg/dL), and creatinine, 92 μmol/L (1.1 mg/dL). Several months after corticosteroid therapy commenced, the patient noted tender nodules on her lower extremities. She was not receiving anticoagulants, did not increase her intake of calcium or phosphate, and was never hypercalcemic.She presented with firm, indurated, painful, subcutaneous nodules and plaques bilaterally on her calves and thighs with surrounding livedoid erythema. An incisional biopsy specimen was remarkable for abundant calcification in the deep reticular dermis and septae of the panniculus without vascular involvement or inflammatory response (Figure 1). The von Kossa

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