Subcutanous thrombotic vasculopathy

    77 year old male with complex past medical and surgical history including:

    • diabetes mellitus
    • end-stage renal disease (hemodialysis dependent)
    • atrial fibrillation
    • coronary artery
    • disease, myocardial infarctions
    • ischemic cardiomyopathy (ejection fraction of 30%)
    • hypertension
    • hypercholesterolemia
    • congestive heart failure
    • pulmonary hypertension
    • cervical spinal stenosis
    • end-stage renal disease
    • abdominal aortic aneurysm repair
    • right foot transmetatarsal amputation
    • cataract surgery bilateral
    • depression
    • gout
    • gastroesophageal reflux disease

    Patient consulted by dematology to evaluate progressive large retiform  palpable purpuric plaque on the abdomen. It was associated with overlying bullae a firm tender dermal hardening.