[Clinical Picture] Acral retiform purpura

A 68-year-old man with a 10-year history of progressive IgG λ multiple myeloma and chronic kidney disease presented with a 3-week history of a painful rash on both his soles and palms, on a background of acute renal failure requiring haemodialysis. On examination he had petechiae and stellate macular purpura coalescing into retiform patches on both feet, wo rse on the soles (figure). A punch biopsy sample of the left palm showed mild perivascular inflammation with sparse karyorrhectic debris, extravasated red blood cells, and intravascular eosinophilic non-polarisable crystals (figure).
Source: LANCET - Category: General Medicine Authors: Tags: Clinical Picture Source Type: research