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

BMJ 2021; 375 doi: (Published 04 November 2021) Cite this as: BMJ 2021;375:n2511
  1. Melanie Etti, clinical fellow,
  2. Gurjinder Sandhu, consultant in infectious diseases and general medicine
  1. Ealing Hospital, Southall, London
  1. Correspondence to: M Etti melanie.etti{at}

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 …

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