LAUSR

A 6-year-old boy treated with chronic hemodialysis, presented with an ulcerative lesion on his left fifth toe (Fig. 1). He had presented at 4 months of age with end-stage kidney disease and was diagnosed with primary hyperoxaluria type 1 (PH1) due to homozygous mutation in AGXT. He has been treated since with chronic hemodialysis six days per week, through a central venous catheter. He was afebrile and hemodynamically stable. Physical examination was remarkable for short stature, severe hepatosplenomegaly, and bone deformities due to recurrent pathological fractures. The central venous catheter exit site looked well with no signs of infection. Ophthalmological examination revealed retinal oxalate deposits and bilateral macular fibrosis. His skin lesion was suspected to be pyogenic granuloma and repeated topical application of silver nitrate was unsuccessful. Local excision of the entire lesionwas performed. Microscopic examination of the lesion is shown (Fig. 2).