A woman in her mid-70s with a history of type 2 diabetes mellitus, end-stage renal disease, and coronary artery disease was admitted to the hospital for fever, lethargy, and altered mental status. On day 7 of her hospital stay, she developed severe, unremitting left ankle pain with purpuric lesions on the skin. She had previously undergone coronary artery bypass grafting with simultaneous aortic valve replacement and ileal conduit urinary diversion as a result of to recurrent upper urinary tract infections. Laboratory findings were significant for neutrophil-predominant leukocytosis (leukocyte count, 19 400/μL [to convert to ×109/L, multiply by 0.001]).
Aronica JC, Radfar A, Damavandy AA. Unilateral Stellate Purpura of the Ankle. JAMA Dermatol. 2015;151(10):1125-1126. doi:10.1001/jamadermatol.2015.2022