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We check IGF-1, fasting glucose, and a relevant metabolic panel before prescribing anything

Progressive oral gangrene probably due to lack of catalase in the blood (acatalasemia) The Lancet

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It points to acetaminophen, which the post says does not inhibit protective gastric prostaglandins or reduce renal blood flow

Yao C, Guan X, Carraro G, Parimon T, Liu X, Huang G, Mulay A, Soukiasian HJ, David G, Weigt SS, Belperio JA, Chen P, Jiang D, Noble PW, Stripp BR (2021) Senescence of Alveolar Type 2 cells drives progressive pulmonary fibrosis