Purpura in the Duodenum

Abstract

Question: A 71-year-old white man was admitted with a chronic watery diarrhea (>10 bowel movements per day; lasting 8 weeks) and a severe weight loss (5 kg in the last 2 weeks). He denied any other symptoms, namely abdominal pain, visible blood loss, vomiting, or fever. On physical examination, the most remarkable finding was the presence of multiple, diffuse, small, palpable purpuric lesions in both legs with coalescing lesions (Figure A). No peripheral edema was noted. Laboratory demonstrated a mild normocytic anemia (hemoglobin, 9.4 g/dL), slightly elevated coagulation tests (International Normalized Ratio, 1.3), elevated erythrocyte sedimentation rate (ESR; 68 mm/h), and a low serum albumin level (2.2 g/dL).