Case 31-2001

Presentation of CaseA 70-year-old woman was admitted to the hospital because of dyspnea and multiple cutaneous ulcers.The patient had a history of long-standing type 2 diabetes mellitus as well as an old myocardial infarct and a remote history of triple coronary-artery bypass surgery; she also had paroxysmal atrial fibrillation, congestive heart failure, peripheral vascular disease, and end-stage renal disease, which was being treated by peritoneal dialysis. Anticoagulation with warfarin was started six months before admission; the dosage of the drug had not changed recently.Twenty days before admission, the patient was admitted to another hospital because of areas . . .