Acta Dermato-Venereologica 99-3CompleteContent | Page 31

353 Diffuse Purpura on the Abdomen and Extremities: A Quiz Grigorios THEODOSIOU 1 , Iva JOHANSSON 2 and Åke SVENSSON 1 1 Department of Dermatology and Venereology and 2 Department of Pathology and Cytology, Skåne University Hospital, Scaniaplatsen 5, SE-211 17 Malmö, Sweden. E-mail: [email protected], [email protected] A 55-year-old man was referred to the outpatient clinic of our department with suspected vasculitis. The patient was admitted to the emergency department due to a progressive worsening of his general condition, anemia and rash. He was a homeless, unemployed, single man with a history of alcohol overconsumption. He had poor dentition without gingival bleeding. He had small, non-infiltrative perifol- licular purpuric papules symmetrically distributed on his abdomen, arms and legs (Fig. 1a, b). Dermatoscopic examination highlighted the presence of coiled hairs sur- rounded by a purple to violaceous peripheral ring (Fig. 1c, d). Histopathology revealed the presence of extravasated erythrocytes in a perifollicular distribution, follicular hyper- keratosis with coiled, fragmented hairs in a hyperkeratotic follicular material (Fig. 2). What is your diagnosis? See next page for answer. Fig. 1. a, b: Perifollicular, hyperkeratotic papules. c, d: Contact non-polarized dermatoscopy: coiled hairs surrounded by a violaceous halo. QUIZ SECTION Fig. 2. a, b: Dilated follicular infundibulum with hyperkeratosis and cork screw hair. c, d: Perifollicular lymphohistiocytic infiltrate with extravasated erythrocytes without signs of vasculitis (hematoxylin-eosin stain: a: 20x, b: 100x, c, d 400x). This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta Journal Compilation © 2019 Acta Dermato-Venereologica. doi: 10.2340/00015555-3113 Acta Derm Venereol 2019; 99: 353–354