A patient with renal failure of unknown etiology requiring dialysis went to get a pan-body CT/MRI three weeks ago. She is fairly wealthy and paid for as many fancy technological scans as possible in an attempt to identify the cause of her renal failure. Today, she presents with the lesion shown in the first image. These lesions developed symmetrically on bilateral ankles, lower legs, feet, and hands. Then they may progress to the thighs, forearms, trunk, and buttocks. The second image shows a later stage.
CRP, serum ferritin, and ESR are elevated; albumin is low. ANA, anticentromere, and anti-Scl-70 antibodies are negative.
Challenge: What happened?
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