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A patient with atherosclerosis and livedo reticularis
  1. J L Rodríguez-Garcíaa,
  2. R Manzanob,
  3. C Mirac
  1. aHospital General La Mancha Centro, Alcázar de San Juan, Ciudad Real, Spain: Service of Internal Medicine, bService of Dermatology, cService of Pathology
  1. Dr José Luis Rodríguez-García, Servicio de Medicina Interna, Hospital General La Mancha Centro, Avenida de la Constitución nº 3, 13600 Alcázar de San Juan, Ciudad Real, Spainjlgarcia{at}serconet.com

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Answers on p 210.

A 73 year old man was admitted with progressive dyspnoea. His past medical history included peripheral artery disease (intermittent claudication of lower extremities) and ischaemic heart disease (angina pectoris). Two months before renovascular hypertension was diagnosed after he presented severe hypertension and mild renal insufficiency (plasma creatinine concentration 150.3 μmol/l). Renal angiography showed a solitary stenosis of his left renal artery. He had undergone a renal angioplasty two weeks before admission. On examination he had signs consistent with cardiac failure with pulmonary oedema; systolic blood pressure was 180 mm Hg and diastolic 100 mm Hg. A reticulated reddish mottling of the skin was seen on his feet (fig1). His plasma creatinine concentration was 353.6 μmol/l. A skin biopsy specimen revealed needle-shaped crystals in his small arteries (fig 2). The patient's condition continued to deteriorate; he was treated with vasodilators, diuretics, and pentoxifilline but developed progressive renal insufficiency and refractory heart failure and died 10 days after admission.

Figure 1

Patient's foot showing reticulated reddish mottling.

Figure 2

Skin biopsy specimen showing needle-shaped crystals in the small arteries (arrowed).

Questions

(1)
What does fig 1 show?
(2)
What kind of crystals are those observed on the skin biopsy sample (fig 2)?
(3)
What is the final diagnosis?

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