Purpura and Recurrent Ulcers on the Lower Extremities

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Abstract
REPORT OF A CASE A 22-year-old man presented to the dermatology clinic at the University of Miami (Fla) with a 1½ -year history of purpuric lesions, some of which had progressed to painful ulcerations over his lower legs and the dorsolateral aspect of his feet. His medical history was not significant and he denied a history of abnormal bleeding, Raynaud's phenomenon, sensitivity to cold, or the use of medications. Cutaneous examination showed purple-brown macular lesions on his lower legs, spreading from the medial malleoli to the lateral and medial aspects of the feet (Fig 1). Similar lesions were noted on the forearms distally. Superficial painful ulcers of various sizes were evident over the medial malleoli and over the dorsal aspect of the feet. The remainder of the physical examination showed normal findings. Laboratory studies showed the following normal or negative results: complete blood cell count, platelet count, erythrocyte sedimentation rate,

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