Advanced type 1 hyperoxaluria presenting as livedo racemosa in a patient with end-stage renal disease

On examination, the skin showed livedo racemosa as seen in [Figure 1]a, [Figure 1]b, [Figure 1]c, [Figure 1]d.{Figure 1} Blood test showed leucocytosis [12 × 106/mL, normal range 8–10.5 × 106/mL], highly elevated creatinine (9.28 mg/dL, normal values 0.8–1.1 mg/dL), creatine phosphokinase (2228 U/L, normal 1–7.5 U/L), and C-reactive protein levels (293 mg/L, normal limits 0–5 mg/L). [...]acute arterial occlusion, cholesterol emboli, and nephrogenic systemic fibrosis were ruled out. The clinical diffuse appearance did not support the diagnosis of uric acid crystal deposition. [...]two skin biopsies were taken, one from the palm and the other from the distal region of the leg.