Case 35-2004: A 68-Year-Old Man with End-Stage Renal Disease and Thickening of the Skin

Thickening of the skin of the arms and legs, with flexion contractures of the knees, elbows, fingers, and toes, developed in a 68-year-old man with long-standing diabetes mellitus complicated by retinopathy, neuropathy, and renal failure. He was unable to walk and had nonhealing ulcers on both heels. Examination disclosed brown-pigmented, indurated plaques on the arms and legs. A diagnostic procedure was performed. Thickening of the skin developed in a 68-year-old man with diabetes mellitus. Examination disclosed brown-pigmented, indurated plaques on the arms and legs. Presentation of Case Dr. Amin Fazeli (Dermatology): A 68-year-old man was evaluated in this hospital by a dermatologist because of progressive thickening of the skin of the arms and legs. The patient had had type 2 diabetes mellitus for 35 years, complicated by end-stage renal disease that required hemodialysis, diabetic neuropathy that resulted in leg pain and difficulty walking, chronic foot ulcers, and retinopathy; he was legally blind. He had coronary artery disease that had necessitated bypass grafting of four vessels, paroxysmal atrial fibrillation, and hypertension. For the seven months before the evaluation, progressive thickening of the skin, particularly of . . .