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JAMA Dermatology Clinicopathological Challenge
June 2015

Purpuric Lesions on Acral Sites

Author Affiliations
  • 1Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut

Copyright 2015 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.

JAMA Dermatol. 2015;151(6):659-660. doi:10.1001/jamadermatol.2014.5198

A woman in her 80s with a history of nonischemic cardiomyopathy and chronic kidney disease presented with purpuric lesions on her face, elbows, knees, and feet. She was initially admitted for altered mental status in the setting of an unwitnessed fall and was noted to have “bruises” on her lower extremities. Dermatology was consulted after the development of new lesions on her nose, ear, and the extensor surfaces of her arms bilaterally. Admission laboratory test results showed hypercalcemia (calcium level, 11.5 mg/dL) and acute kidney injury (creatinine level, 5.6 mg/dL).