Bruising in a Man in His 60s

Abstract

A white man in his 60s with a history of hypertension presented to his dermatologist with a bruiselike rash of 2 months' duration. He was referred by a hematologist-oncologist whom he had seen for mild erythrocytosis and ecchymoses. The rash was not symptomatic and appeared mostly on the left side of his face and trunk. He had not experienced any trauma in the area. Initially, the bruiselike rash would appear and then spontaneously regress, but it was becoming progressively more persistent. The patient had no history of arsenic or radiation exposure and did not report any accompanying symptoms, including night sweats, fevers, chills, or weight loss. His medications included amlodipine besylate, benazepril hydrochloride, metoprolol tartrate, lisinopril, and over-the-counter daily vitamins.Physical examination revealed brown irregular patches and slightly indurated plaques on the forehead, left temple, preauricular area, left neck, upper chest, and back ( Figure, A and B). The plaque on the left clavicle had recently become raised and measured 2 × 3 cm. Punch biopsies of the left clavicle and left forehead were performed, and tissue was sent for pathologic analysis ( Figure, C and D).