A 52-year-old man with type 2 diabetes mellitus and end-stage renal disease presented with painful and progressive cutaneous necrosis of his fingers, toes, and calves and generalized muscle weakness with difficulty getting out of bed and walking. He had undergone hemodialysis for the past year and had a brachiocephalic fistula in his left arm. His medical history was also significant for peripheral vascular disease, hypertension, and antiphospholipid antibody syndrome for which he was receiving warfarin sodium since 2010. His other medications were epoetin alpha, ferrous gluconate, cinacalcet hydrochloride, paricalcitol, sevelamer carbonate, amlodipine besylate, labetalol hydrochloride, lisinopril, simvastatin, pentoxifylline, and Humalog and Lantus insulin. He did not smoke.
Jane H. Kim, Stephen Somach, Christopher R. McHenry. Progressive Soft-Tissue Necrosis. JAMA Surg. 2014;149(2):211–212. doi:10.1001/2013.jamasurg.356