Contributed by Swaminathan Rajendiran, MD and Uma N M Rao, MD
Published on line in August 1999
The patient is a 30 year old female with a long history of end stage renal disease due to polycystic kidneys. She is currently on her second cadaveric graft, functioning mostly well with a creatinine stable in the mid 2 mg/dl for many years (first transplant 1976 and the second 1988) She was transplanted under cyclosporine immunosuppression. She presented this time to the hospital with the complaints of swollen and painful left index finger. On examination the finger showed a large ulcer of the skin surrounded by severe inflammation. The ulcer was not healing despite debridement and so it was decided to amputate the finger. Her current medications include sandimmune, sodium bicorbanate, colchicine, coumudin, zantac, lasix, hydralazin, Prednisone and atenolol.