Contributed by Shashi Ariyanayagam-Baksh MB, BS and John Abernethy MD, PhD
Published on line in January 2000
The patient is a 67 year old white male who underwent orthotopic cardiac transplantation in 1986 for cardiomyopathy. He was maintained on immunosuppressive therapy with FK-506 and prednisone since that time. He subsequently developed chronic renal failure due to FK-506 toxicity and has been on hemodialysis for the last two years. Dialysis access was via a loop left forearm AV graft, which was performed in April 1999 following failure of the original straight graft.
In October, 1999 he presented to the dermatology clinic with multiple cutaneous lesions of the left forearm. Examination revealed multiple violaceous and suppurative nodules and ulcers on the lateral aspect of the left forearm with upward extension in a linear or lymphangitic pattern (Fig 1). Just distal to the antecubital fossa, well healed, surgical incisional scars were also seen.
Fungal, mycobacterial and bacterial cultures were performed and an incisional biopsy of a representative lesion was submitted.