A 55-year-old woman was hospitalized with pain and ulcers on the right breast, fourth digit of the right hand, and left fifth toe. She had hypertension, end-stage renal disease (ESRD) for which she was receiving hemodialysis, atrial fibrillation, and coronary artery disease, and she was morbidly obese (body mass index, 45 kg/m~2). Medications included aspirin, metoprolol, atorvastatin, sevelamer, and isosorbide mononitrate. The patient denied using tobacco, alcohol, or illicit drugs. For the past year, she had been taking warfarin only intermittently and had discontinued it altogether a month before presentation. About 10 days earlier, painful hyperpigmented, violaceous, and indurated plaque-like ulcers with central eschar developed on the patient's right breast. She had fever and chills while undergoing dialysis, which prompted the hospital admission.
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机译：一名55岁的妇女因右乳房，右手四指和左五趾的疼痛和溃疡入院。她患有高血压，终末期肾病（ESRD），正在接受血液透析，房颤和冠状动脉疾病，病态肥胖（体重指数，45 kg / m〜2）。药物包括阿司匹林，美托洛尔，阿托伐他汀，司维拉姆和单硝酸异山梨酯。患者拒绝使用烟草，酒精或非法药物。在过去的一年中，她只间歇性地服用了华法林，在给药前一个月就完全停药了。大约10天前，患者右乳房出现了色素沉着，色素沉着，硬结斑样溃疡，并伴有中央焦。她在接受透析时发烧和发冷，这促使她入院。
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