Lower limb ecchymosis in a man with a history of alcohol misuse

A man in his 50s presented with a two week history of a large ecchymosis on his left ankle and foot, and a two month history of petechial rash on his lower limbs (fig 1 and fig 2). He had no history of recent trauma, fevers, night sweats, weight loss, or upper respiratory symptoms, and did not report any bleeding from other sites. His diet largely consisted of ready meals and he had not consumed fresh fruit or vegetables for more than a year. Fig 1 Large ecchymosis over patient’s left ankle and foot, with hyperkeratosis of skin overlying dorsal and lateral aspects of the foot. Multiple perifollicular haemorrhages on medial aspect of patient’s right lower leg Fig 2 Perifollicular haemorrhages surrounding prominent hyperkeratotic follicles with multiple corkscrew hairs on patient’s right lower leg (black arrows) He said that he had not used alcohol or injected drugs in the past six …