A Man with Chronic Leg Edema, Purpuric Skin Lesions, and Abdominal Lymphadenopathy

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In August 2004, a 42-year-old white man presented with an 8to 12-month history of chronic bilateral leg edema and nonthrombocytopenic, purpuric skin lesions; these symptoms were concurrent with intentional weight loss of 34 kg (from 136 to 102 kg), to treat obesity. The patient also complained of some increased shortness of breath on exertion, occasional dry cough, loose stools, and intermittent left-ankle arthralgia. He denied experiencing fever or night sweats. His medications includ a diuretic and potassium. He was divorced and worked as an electronic technician. Vital signs and the oxygen saturation level normal. Diffuse skin pigmentation was noted, as we e nonpalpable purpuric skin lesions on both arms (figure 1) nd bilateral leg edema below the knees with grade 2+ pitting. Hemogram findings and the sedimentation rate were normal, as were the findi g of a metabolic profile and urinalysis. The