Attending Dermatologist: Susan Massick, MD

Dermatopathologist: Catherine Chung, MD

Medical Student: Cory Petit


60 year old man with a past medical history of pancreatic neuroendocrine tumor, mast cell activation syndrome, hypertension, thoracic aortic aneurysm, rosacea and obesity presents to dermatology with complaints of a dark rash on his legs for the past year. The rash is asymptomatic—no itching, dryness, pain or blistering. It is, however, unsightly and persistent. It does not wax or wane. He does not use any lotions or creams regularly, and has not attempted to put anything on the rash. He has complaints of chronic diarrhea, flushing, shortness of breath, and dry eyes. His current medications include antihypertensives, cromolyn, minocycline, furosemide, and octreotide.

Figure 1: Right thumb

Figure 2: Right posterior calf

What is the most likely diagnosis?

  1. Calciphylaxis
  2. Coumadin skin necrosis
  3. Cryoglobulinemia
  4. Cholesterol emboli