What Is the Cause of This 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