Abstract
A 64-year-old man with a history of celiac disease (CD), congestive heart failure, and diabetes mellitus complicated by end-stage renal disease and peripheral neuropathy, was admitted to the hospital for non-healing ulcerations of his hands with osteomyelitis from his peripheral arterial vascular disease. He reported that his CD was under good control with a strict gluten-free diet prior to admission. Physical exam revealed prominent petechiae on his bilateral palms and fingers (Fig 1). A biopsy was performed and demonstrated collections of neutrophils in the papillary dermis (Fig 2).
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