Intended for healthcare professionals

Endgames Case Review

A historic disease still prevalent today

BMJ 2017; 356 doi: (Published 16 March 2017) Cite this as: BMJ 2017;356:j1013
  1. Lorne V Mitchell, clinical fellow in dermatology1,
  2. Matthew R Wilson, haematology registrar2,
  3. Susan Holmes, consultant dermatologist1
  1. 1Walton Building, Glasgow Royal Infirmary, Glasgow, UK
  2. 2Beatson West of Scotland Cancer Centre, Glasgow, UK
  1. Correspondence to L Mitchell lorne.mitchell{at}

A 79 year old man was referred to the medical assessment unit by his general practitioner. Over the previous four weeks he had experienced progressive discolouration of both lower legs. His GP had given two courses of antibiotics for possible cellulitis but there was no clinical improvement.

He was systemically well and had no history of fever. He denied any trauma to the legs and had no dermatological history. He was taking no regular medication.

The man lived alone and was fully independent. His diet lacked fruit and vegetables.

On examination he had normal pulse, blood pressure, and oxygen saturations and no fever. Chest and abdominal examination were unremarkable. There was widespread bruising (ecchymosis) of the lower legs with “woody” oedema (fig 1). Inspection of the legs more proximally revealed perifollicular haemorrhage and “corkscrew” hairs (fig 2, fig 3). The right leg appeared larger than the left but the calf was soft and non-tender.

Fig 1 Right lower leg

Fig 2 Skin changes above the right knee

Fig 3 Close-up of skin changes above the right knee

A coagulation screen, renal, and liver function tests were normal. Doppler ultrasound of the leg showed no evidence of deep vein thrombosis. Urinalysis was normal. …

View Full Text

Log in

Log in through your institution


* For online subscription