Derm Dx

A 71-year-old woman presented with expanding necrolytic erythema on her tongue and perineum. Her history was remarkable for eczema, anemia, and painful glossitis during the previous year. She had experienced nausea and vomiting for 6 months and “striking” 20 kg weight loss during the preceding 18 months. She'd had a recent attack of deep vein thrombosis and transient ischemia. What's your diagnosis?

Courtesy Dr. Paul Vandersteen