A 56-year-old Caucasian female with end-stage liver disease secondary to ␣1-antitrypsin deficiency and end-stage renal disease secondary to idiopathic membranous nephropathy presented with a one-week history of increased bilateral lower extremity edema and anasarca. On admission, the patient complained of raised hardened areas especially prominent on the upper medial thighs that were painful, warm, and nonpruritic. She denied any constitutional symptoms and denied using any new medications. On exam, the patient was found to be afebrile with stable oxygen saturation. The abdomen was distended with evidence of hepatomegaly. Bilateral lower extremity edema to the groin were present, and hyperpigmented plaques ( Fig. 1) (tender, indurated, and warm) were noted on the upper medial aspects of her thighs, but not involving the groin. There was no visible face or upper extremity involvement.Laboratory tests did not reveal leukocytosis or eosinophilia. ESR was 40 and ANA test was negative. Serum protein electrophoresis was negative for paraproteinemia. Doppler ultrasound did not reveal deep venous thromboses. The patient received a short course of antibiotics without any clinical improvement. A skin punch biopsy revealed increased dermal fibroblast proliferation, thick collagen bundles with surrounding clefts, elastic fibers, and increased mucin deposition consistent with NFD ( Fig. 2 and 3). The patient declined any steroid treatment and was subsequently discharged.Eventually the patient underwent liver transplant and received oral prednisone as part of the immunosuppression regimen, which has led to some improvement of the cutaneous lesions. Currently she has extensive skin contraction involving her calves and shins with decreased range of motion, and she has become largely wheelchair bound. Nephrogenic Fibrosing Dermopathy (NFD) is a recently described derma- From the

European Journal of Surgical Oncology 31 (2005) 1213-1215. doi:10.1016/j.ejso.2005.06.007Received by publisher: 0000-01-01Harvest Date: 2016-01-04 12:22:46DOI: 10.1016/j.ejso.2005.06.007Page Range: 1213-121