A 55 years old, chronic diabetic and hypertensive patient with previous history of right hemiplegia develops end stage renal disease. He undergoes renal transplantation. Nine months later a kidney biopsy performed for evaluation shows a cellular reaction. Subsequently, his immunosuppressive regimen is escalated.Two months later, he develops multiple necrotic nodular lesions on his thigh where he takes his insulin injections. A skin biopsy of the lesion is performed.
Histopathology shows inflammatory infiltrate and deep magenta staining rounded structures. What treatment should be immediately initiated and what further tests for the biopsy sample can detect the cause? Source: Kulkarni A, Sinha M, Anandh U. Saudi J Kidney Dis Transpl 2012.
