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JAMA Dermatology Clinicopathological Challenge
February 2016

Bruising and Hemorrhagic Vesicles on the Tongue

Author Affiliations
  • 1School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill
  • 2Department of Dermatology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill
JAMA Dermatol. 2016;152(2):207-208. doi:10.1001/jamadermatol.2015.4065

A woman in her 70s with recently diagnosed diastolic heart failure was admitted for worsening dyspnea. Her medical history was notable for hypertension and oral lichen planus. Over the previous 2 to 3 months, the patient also reported easy bruising with minor trauma and erosions on the lateral tongue.

Findings from physical examination revealed perioral and periorbital purpura, some of which she attributed to friction from her nasal cannula (Figure, A). Hemorrhagic vesicles and petechiae were distributed over the lateral tongue (Figure, B) and buccal mucosa. Additional petechiae and purpura were noted on her lower extremities, including inguinal fold, thigh, and crura.

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