What Is the Cause of This Ankle Ulceration?

ankle ulceration

A 42-year-old man with end-stage renal disease and hypertrophic cardiomyopathy presented with a black eschar followed by ulceration on his right ankle 3 months after a deceased donor renal transplant and orthotopic heart transplant while on an immunosuppressive regimen of mycophenolate mofetil, prednisone, and tacrolimus. His post-transplant course was complicated by carbapenem-resistant Enterobacter cloacae bacteremia, nephropathy from BK virus infection, and acute kidney rejection. He works as a project manager for a construction company, has a pet dog, and denied recent travel. Physical examination revealed a 3 x 2-cm well-circumscribed, friable, gray-red plaque without surrounding cellulitis or edema of the right lateral ankle  (Figure 1). 

What is Your Diagnosis?

Answer on page 2

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