SECTION EDITOR: MARY S. STONE, MD; ASSISTANT SECTION EDITORS: SOON BAHRAMI, MD; CARRIE ANN R. CUSACK, MD; SENAIT W. DYSON, MD; MOLLY A. HINSHAW, MD; ARNI K. KRISTJANSSON, MD
A 36-year-old woman presented to the emergency department after a near-syncopal episode complaining of a 3-week history of vaginal, rectal, and gingival bleeding as well as red spots and bruising on her body. She had a history of chronic fatigue syndrome for many years, which had worsened in the last few months to the point that she rarely left her house and spent most of her time in bed. She reported a poor appetite and 20-pound weight loss. She was not taking any medications or herbal or dietary supplements. Physical examination revealed multiple, discrete, folliculocentric erythematous macules on the lower extremities (Figure 1). Large ecchymotic patches were present over the buttocks and posterior thighs. A punch biopsy of the right thigh was performed (Figure 2 and Figure 3).
Kurtzman D, Dupont J, Lian F, Curiel-Lewandrowski C. Fatigue and Lower-Extremity Ecchymosis in a 36-Year-Old Woman—Quiz Case. Arch Dermatol. 2012;148(9):1073-1078. doi:10.1001/archderm.148.9.1073-d