An 82-year old hemodialysis patient presented with a painful rash on his left arm. His-dialysis access was on this arm for more than ten years (synthetic PTFE graft). Within a week there was a non-palpable erythematous, sharply defined cutaneous lesions which were painful upon palpation (Fig 1). Proximal the lesions resembled purpura, more distal there were flat vesicles, partially confluent to larger lesions. The cutaneous abnormalities were limited exclusively to the left arm. The patient had been treated with radiotherapy for larynx carcinoma 3 months earlier.
