A 40-year-old white man was hospitalized for a possible leg infection. Although the patient was not in pain, a history of recurrent leg infections had prompted his admission. The man was 5 ft 9 in tall and weighed almost 500 lb. Pebbly plaques that were hard to the touch manifested on his legs. The patient had acanthosis nigricans on his neck and onychomycosis of his toenails. His medical history included type 2 diabetes, hypertension, and hypercholesterolemia inadequately controlled with insulin, atenolol, hydrochlorothiazide, and atorvastatin, perhaps due to noncompliance. The patient had tried physical therapy and compression hose to improve the appearance of his legs.

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