Painful medial thigh ulcer

A 74-year-old female with a past medical history of type II diabetes mellitus and end-stage renal disease on hemodialysis and warfarin presented with a new, painful ulcer on her left inner thigh. Gross examination showed retiform purpura with central ulceration and black-brown crusting (Fig 1, A). A biopsy was performed, and histopathological examination of the lesion showed full-thickness ischemic necrosis with overlying ulceration and diffuse dermal angiomatosis with scattered calcification deposits around the subcutaneous vessels in the subcutaneous septae (Fig 1, B).

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