RT Journal
A1 Chang HJ
T1 LOwer extremity purpura
JF JAMA
JO JAMA
YR 2011
FD May 11
VO 305
IS 18
SP 1911
OP 1912
DO 10.1001/jama.2011.567
UL http://dx.doi.org/10.1001/jama.2011.567
AB 
A 50-year-old woman comes to your office for evaluation of a vasculitic-appearing cutaneous eruption of unknown duration on the lower extremities. Her medical history includes heavy smoking with subsequent chronic obstructive pulmonary disease (COPD). Findings from a general physical examination show her to be a cachectic woman who appears older than her stated age. Cutaneous examination reveals a perifollicular, hyperkeratotic purpuric eruption on her lower extremities (Figure 1). Pertinent laboratory values showed megaloblastic anemia, low serum folate levels, and a mild elevation of liver function test results.1