REPORT OF A CASE
A 65-year-old man was admitted to the Erie County (New York) Medical Center with epigastric pain, weakness, fatigue, and difficulty walking. A dermatology consultation was requested to evaluate a purpuric eruption on his legs. He had a history of alcohol abuse, cirrhosis, and emphysema. The epigastric pain had been present for 2 weeks and was associated with increased alcohol consumption (24 cans of beer per day). The weakness, fatigue, and difficulty walking had been present for many months, and he had not left his home for 9 months. He was receiving no medicine but had been taking aspirin intermittently.On physical examination he appeared unkempt, very thin, and unshaven. His conjunctiva were pale and dentition was poor. There were two areas of gingival hemorrhage. Examination of the skin revealed a nonpalpable purpuric eruption on the forearms, thighs, and legs. There was a large ecchymosis over the