Thanks Miles V. for sharing this photo of a PKM in Chechnya.
The photo was posted on Twitter by @Rufus_McDonald
Chechen Anjad al-Kavkaz fighter posing with a heavily modified PKM. A foregrip, C79/M145 scope, MultiCam camo & butt-pad have been added.
This PKM is very different from your stereotypical PKM.
Here is a regular PKM.
Looking at the photo Miles shared, the stock has been removed and a butt pad has been attached to the back of the receiver. More importantly, the grip and trigger have been shifted forward. They are usually directly underneath the charging handle. The ammo box is canted forward, which I assume is necessary to make room for the relocated grip and trigger. A makeshift rail system has been added so that the shooter can use a vertical grip. I imagine the balance of this particular customized PKM makes it much easier to shoot off hand for longer periods of time as well as making it easier to manipulate.