Cholesterol embolism

Cholesterol embolism usually occurs after invasive vascular procedure, and it marked by discoloration of distal circulatory fields such as the pads of the toes, as above.  The blotchy, discolored appearance, especially if sudden in onset, is referred to as "blue toe syndrome" and is very highly suggestive of cholesterol emboli.  Some of you noted the pincer nails and onychomycosis, but the reality is, given the clues all of you should have honed in on the vascular hints and nailed this one.  Pun intended.