Scottsdale 2012 Didactic Session V Case Vignette 12

     59 year-old woman with history of diabetes since age 19 and complex medical history including end-stage renal disease presented with 6 month history of hard violacous palques and nodules on inner thighs. The nodules are painful and ulcerate. These were considered to be pyoderma gangrenousm by an outside physician.

    The biopsy showed thrombotic vasculopathy involving subcutaneous fat. A hypercoagulable state workup revealed negative anticardiolipin antibodies, normal protein C, protein S, beta 2 glycoprotein-1 levels, normal PT, PTT, heparin-dependent antibody , no evidence of factor II and factor V Laiden mutations. Lupus anticoagulant was reported as equivocal. Serum calcium levels were within the normal limits.