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).
Juliet Fraser Gibson, Jonathan Scott Leventhal, Brett King. Purpuric Lesions on Acral Sites. JAMA Dermatol. 2015;151(6):659–660. doi:10.1001/jamadermatol.2014.5198