A 64-year-old woman with a 38-year history of hemodialysis presented with general weakness. Until 3 days before presentation, she had been hospitalized for one month due to bullous pemphigoid involving the oral mucosa, during which she was treated with minocycline and nicotinamide and placed on a soft renal diet. Physical examination revealed no paralysis, and brain MRI excluded stroke. Laboratory tests showed severe anemia (hemoglobin 6 g/dL), and she was admitted for transfusion. On hospital day 10, she experienced recurrent weakness, right thigh swelling, and subcutaneous hemorrhage (Fig.
