Peripheral artery disease and unusual skin findings

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Figure 1
The patient’s lower back and buttocks on initial presentation.
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Figure 2
The patient’s lower extremities demonstrated evolving livedo reticularis.
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Figure 3
The patient’s right flank (left), lower back (middle), and right hip (right) demonstrated evolving ulceration and necrosis of lesions seen in Figure 1.
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Figure 4
The patient’s flank ulcer 2 months after treatment.

TABLE 1

The patient’s laboratory evaluation 5 months earlier

Test	Value^{^a}	Reference range
Erythrocyte sedimentation rate	12 mm/hour	0–10
C-reactive protein	0.90 mg/L	< 5.00
Antineutrophil cytoplasmic anti-	< 1:20	< 1:20
bodies immunoglobulin (Ig) G
Rheumatoid factor	10.2 IU/mL	0–14.0
Cardiolipin IgA	4.9 APL units	0.0–13.9
Cardiolipin IgG	4.5 GPL units	0.0–9.9
Cardiolipin IgM	< 2.5 MPL units	0.0–9.9
Nuclear antibody IgG	< 1:40	< 1:40
Cryocrit	< 1%	< 1%

TABLE 2

The patient’s laboratory results on admission

Test	Value^{^a}	Reference range
Glucose	88 mg/dL	70–100
Sodium	125 mmol/L	135–148
Potassium	4.0 mmol/L	3.5–5.3
Chloride	93 mmol/L	92–108
Bicarbonate	18 mmol/L	22–30
Blood urea nitrogen	17 mg/dL	8–23
Creatinine	0.82 mg/dL	0.50–1.00
Calcium	7.7 mg/dL	8.2–9.6
Albumin	2.8 g/dL	3.8–5.1
Hemoglobin^{^b}	9.9 g/dL	13.1–17.5
Platelet count	328 × 10⁹/L	150–400
White blood cell count	14.8 × 10⁹/L	4.0–10.0
Hematocrit^{^b}	28.4%	40.0-51.0%
Red blood cell count	3.31 × 10¹²/L	4.6–6.0
Mean corpuscular volume	85.8 fL	80–100.0
Absolute neutrophil count	11.4 × 10⁹/L	1.7–6.5
Absolute lymphocyte count	1.3 × 109/L	8.0–4.0
Absolute monocyte count	1.2 × 10⁹/L	0.2–1.0
Automated absolute neutrophil count	9.9 × 10⁹/L	1.7–6.5
Absolute eosinophil count	1.0 × 10⁹/L	< 0.6

↵a Abnormal results are shown in bold.
↵b Previous studies showed microcytic iron deficiency anemia with low ferritin, serum iron, and transferrin saturation.

TABLE 3

Follow-up laboratory evaluation at the time of skin biopsy

Test	Value^{^a}	Reference range
Erythrocyte sedimentation rate	104 mm/hour	0–10
C-reactive protein	198.10 mg/L	< 5.00 mg/L
Antineutrophil cytoplasmic antibodies	< 1:20	< 1:20
immunoglobulin (Ig) G
Rheumatoid factor	10.7 IU/mL	0–14.0
Beta 2 glycoprotein IgG	1 U/mL	0–20
Beta 2 glycoprotein IgM	1 U/mL	0–20
Cardiolipin IgA	9.9 APL units	0.0–13.9
Cardiolipin IgG	6.7 GPL units	0–9.9
Cardiolipin IgM	< 2.5 MPL units	0–9.9
Nuclear antibody IgG	< 1:40	< 1:40