REPORT OF A CASE
A 73-year-old woman presented during the summer with a 3-month history of easy bruising and asymptomatic progressive purpuric areas on both the lower legs and ankles. Review of systems was significant for increased fatigue over the past several months. Her medical history was unremarkable.Physical examination of the skin revealed multiple focal and grouped, nonpalpable pigmented purpuric lesions of the lower legs and feet, some of which were in stellate configurations (Figs 1 and 2).Two biopsy specimens of the lesions were obtained and a representative histologic section is shown (Fig 3).Laboratory studies disclosed the following values or results: hemoglobin, 98 g/L; hematocrit, 0.29; peripheral smear, moderate roleaux formations; erythrocyte sedimentation rate, 105 mm/h (normal, 0 to 20 mm/h); antinuclear antibody, negative; initial serum protein electrophoresis: total protein, 87 g/L (normal, 72 to 85 g/L), and gamma globulin, 33 g/L (normal, 5 to 16
Williams JT, Arrington J, Gruber HM. Purpura as the Presenting Sign of an Internal Disease. Arch Dermatol. 1993;129(6):777–778. doi:10.1001/archderm.1993.01680270117017
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