Abstract
A 72-year-old man presented to his primary care physician witha1-monthhistoryof a lowerextremityulceration. Initially, he had noted a discrete area of warmth and erythema on the pretibial aspect of his right leg that did not blanch with pressure. He denied any recent history of trauma or travel. The area of erythema on his leg enlarged over the followingweeksdespiteoralamoxicillinclavulanatetherapy. Hismedicalhistoryrevealedautoimmunehepatitis,forwhich he had been placed on an oral regimen of prednisone (40 mg/d)andazathioprine(50mg/d)4monthsearlier.A large reticulated area of ulceration on his right lower extremity, withareasof fullnecrosis,wasobservedonphysical examination. The border was well defined, erythematous, bluish, and violaceous (Figure1). The results of a vasculitis workup (ie, serologic tests for antinuclear antibody, rheumatoid factor, and cardiolipin antibody; a cryoglobulin screen; and a cryofibrinogen screen) were negative. A biopsy specimen was obtained (Figure 2). What is your diagnosis?
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