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Case for Diagnosis. Presented by Donald R. Shasky, MD.
The patient is a 23-year-old white housewife with a ten-year history of a slightly pruritic eruption over each ankle. Some lesions are always present. Old ones do fade but are soon replaced by new lesions. She denies taking any drugs. There is no history of intolerance to cold.The patient has a congenital deformity of the lumbar spine and the left hip.
Over each malleolus there are what appear to be groups of purplish-red excoriated vesicles with minimal crusting.
Biopsy of the skin was interpreted as a nonspecific capillaritis with purpura compatible with drug eruption, collagen-vascular disease, and stasis dermatitis. Total protein: 8.4 gm—normal, 6-8 gm Albumin: 4.9 gm—normal, 3.5-5.0 gm Globulin: 3.5 gm—normal, 2.5-3.5 gm A/G Ratio: 1.4/1 α-globulin: 1.65 gm—normal, 0.8-1.2 gm β-globulin: 1.18 gm—normal, 0.9-1.4 gm γ-globulin: 0.70 gm—normal, 0.5-1.2 gm Macroglobulin: 0.26 gm/100cc—normal, (S19) 0.10-0.43
THE METROPOLITAN DERMATOLOGICAL SOCIETY OF LOS ANGELES. Arch Dermatol. 1968;97(4):494-496. doi:10.1001/archderm.1968.01610100134021