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Clinical Images

Hematoma and Petechiae

A 57-year-old white male presented with a painful, swollen left thigh ecchymosis, which had spread to the ankle over the past 2 weeks. He had two similar complaints previously. Other positive history findings included new onset shortness of breath, anorexia, and weight loss. He denied hematemesis, hematochezia, hematuria, bleeding gums, and trauma. His only current medication was an opioid analgesic. He lived alone, ate mostly TV dinners, canned soups, and canned stewed vegetables. He appeared thin, malnourished with a flat affect and irritability. Skin exam revealed a purple hematoma on the left thigh (Panel a) without any palpable purpura. The patient also had diffuse perifollicular petechiae on the upper and lower extremities. There were bruises on the extensor surfaces of the hands, wrists, and forearms. Remainder of physical examination was unremarkable. Microscopic picture (Panel b) showed perifollicular hemorrhage and extravasation of erythrocytes.


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