An 82-year-old male with a history of myocardial infarction for which he had required quadruple coronary-artery bypass grafting presented with mottled-appearing purple discoloration of the skin on his toes. (Image 1) Surgical history Transapical transcatheter aortic-valve replacement (TAVR) one month ago. Laboratory findings Serum creatinine level of 2.8 mg per deciliter, which had increased from a baseline level of 1.4 mg per deciliter White-cell count of 10,200 per microliter with 13% eosinophils (absolute eosinophil count, 1170 per microliter).
A skin biopsy was done.(Image 2) What is the diagnosis? Source: NEJM (Detailed citation will be revealed with the explanation) *This case is from Docplexus Editorial Team for educative purpose only
