UP For the Challenge?

The Nejm 10 Toughest Image Challenges Quiz Test your knowledge and see how you measure up.
 
48,043 TOTAL RESPONSES
Only 11% of Responses Were Correct
Image Challenge: 1 of 10

What's the Diagnosis?

This patient presented with discoloration of his palms and soles. He reported a normal diet and had normal serum creatinine, thyroxine, and bilirubin concentrations. What is the diagnosis?