This 55-year-old woman with a history of hypertension, aortic dissection, and aortic valve replacement on chronic anticoagulation was hospitalized for an acute intrahepatic hematoma. Her 3 month hospital course was complicated by respiratory failure requiring ventilator support, Klebsiella sepsis, acute renal failure and profound anasarca. Her renal failure was transient and patient was eventually transferred to a rehabilitation facility. Though ambulatory before her hospitalization, she was still unable to walk after several months of physical therapy, and on physical examination in dermatology was noted to have severe contractures of her hands and feet asociated with woody indurated dermal plaques. Histologic changes were consistent with nephrogenic fibrosing dermopathy.
contractures with diffuse woody induration and scattered overlying erythematous and hyperpigmented scaly patches