An 88-year-old man presents with a 2-month history of a non-healing ulcer on his right lower limb. The lesions started insidiously as multiple red nodules that progressively became ulcerated and painful. The patient has hypertension and takes warfarin for atrial fibrillation.
The patient has extensive necrotic ulceration of his shin, covered by black hemorrhagic crust. Laboratory findings demonstrated mildly elevated levels of parathyroid hormone, calcium, alkaline phosphatase, and inflammatory markers. His renal function tests showed moderate impairment. Results of a vasculitic screen were negative.
A subsequent 3-mm punch biopsy of the necrotic lesion demonstrated “benign ulceration,” and an arteriogram of the right lower limb showed calcification of the profunda femoris and superficial femoral arteries.
What is your working diagnosis at this point?
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