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Progressive Purpura in a Long-term Care Patient

A man in his 80s presented with a 1-year history of purpura, ecchymoses, anorexia, and weight loss. His medical history included alcohol abuse and cognitive impairment. Purpura and ecchymoses, initially periorbital, progressed over the previous 12 months. Elder abuse was excluded. Examination demonstrated waxy yellow papules and plaques with purpura in the periocular, neck, axillary, trunk, and inguinal regions (Figure, A). Investigations revealed anemia, abnormal liver function test results, and renal impairment with moderate proteinuria. The patient’s serum protein electrophoresis (SPEP) and immunofixation urine protein electrophoresis test results were normal. Radiological studies were unremarkable. Subsequently, a 4-mm punch biopsy specimen was obtained (Figure, B-D). Clinical image A Histopathologic image B