Necrotic and Deposition Disorders

In this column, readers will learn about a patient and be asked to select a diagnosis from a short list based on the information presented; after which, each answer choice will be reviewed, and the correct answer will be revealed. The patient presented here is a 19-year-old Latin woman with insulin-dependent diabetes, diagnosed at the age of 12 years. She presented with painful necrotic lesions on her lower extremities, which were associated with difficulty ambulating. Laboratory analysis showed elevated serum calcium, phosphorous, and parathyroid hormone levels as well as elevated blood urea nitrogen, creatinine, erythrocyte sedimentation rate, and C-reactive protein. Hemodialysis was initiated, and work-up was begun for hypercoagulable states. Renal ultrasound showed multiple renal calcifications, suggesting acute-on-chronic renal disease. Further laboratories were negative for HIV, antinuclear antibody, antineutrophil cytoplasmic antibody, hepatitis, and cryofibrinogen. Within the week of admission and commencement of work-up, this patient unfortunately died from an embolic event.