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A 38-year-old man who had undergone renal and pancreatic transplantation five years earlier was referred because of acral gangrene of both hands. The patient also had type 1 diabetes and was a nonsmoker. Within the previous month, painful paraungual blue spots had developed on three of the patient's fingers, including the fourth digit of his left hand (Panel A); ulcers had then developed on the affected fingers. His renal function had deteriorated, a fact attributed to the effects of infection with polyomavirus type BK. The systemic blood pressure was 130/80 mm Hg, and the segmental arterial pressures in the upper . . . [Full Text of this Article] |
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