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Purpuric lesions in an elderly woman

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A 68-year-old woman presented with a 5-day history of extensive pruritic purpuric skin lesions of varying sizes on her trunk and extremities (FIGURE 1A and 1B). In addition, the patient had a few nonblanching, erythematous macules on her extremities.

Three years earlier, the patient had been given a diagnosis of asthma and since then had been maintained on fluticasone propionate oral inhaler. Recently, she’d experienced unintentional weight loss and malaise.

The patient had no neurological complaints and her family history was negative for a similar condition. We performed a punch biopsy.

WHAT IS YOUR DIAGNOSIS?
HOW WOULD YOU TREAT THIS PATIENT?

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