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JAMA Clinical Challenge
May 11, 2011

Lower Extremity Purpura

Author Affiliations

Author Affiliation: Dr Chang (tina.chang@jama-archives.org) is Contributing Editor, JAMA.

JAMA. 2011;305(18):1911-1912. doi:10.1001/jama.2011.567

A 50-year-old woman comes to your office for evaluation of a vasculitic-appearing cutaneous eruption of unknown duration on the lower extremities. Her medical history includes heavy smoking with subsequent chronic obstructive pulmonary disease (COPD). Findings from a general physical examination show her to be a cachectic woman who appears older than her stated age. Cutaneous examination reveals a perifollicular, hyperkeratotic purpuric eruption on her lower extremities (Figure 1). Pertinent laboratory values showed megaloblastic anemia, low serum folate levels, and a mild elevation of liver function test results.1

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