August 2006

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History: A 43 y/o white male was admitted to the hospital with a 2 year history of petechial lesions (Figure 1, 2) on the bilateral lower extremities and a 2 week history of swelling and pain of the right ankle (Figure 3). He denied any history of trauma, bites, tick exposure, or new medications. Additional findings were significant for submucosal hemorrhage of the oral mucosa (Figure 4) and gingival hypertrophy with bleeding gums (Figure 5).
His past medical history was noncontributory.

Social history was significant for heavy alcohol consumption of approximately 12 beers/day.
He was not taking any medications at time of admission and denied using recreational drugs.
Laboratory data was significant for anemia (hemoglobin of 11.6, hematocrit of 34.1) and leucopenia (WBC 2.1). CMP panel was within normal limits.

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