A 65-yo woman with hepatitis C, cirrhosis, renal impairment, hypertension, and restrictive cardiomyopathy had severe finger pain in both hands for several years, recently progressing to gangrene. What is the underlying cause?
Fungal melanonychia
Scleroderma
Warfarin-induced skin necrosis
Flesh-eating bacteria (necrotizing group A strep)
Cryoglobulinemia-induced vasculitis
You are correct. Cryoglobulins are common in chronic hepatitis C; cryoglobulinemia-induced vasculitis is rare and devastating. The patient died 24 h after this photograph was taken.