Image Challenge of the Week!

A patient presents with the following purpura of several months’ duration with minimal trauma. Platelet count, protime, and partial-thromboplastin time were normal. He takes no medications.

Periocular purpura
Lancet. 2014 Jul 19;384(9939):257.

He has a history of carpal tunnel and recently diagnosed heart failure with preserved ejection fraction.

What diagnosis should be considered in this patient? Scroll down for answer.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Answer:

AL amyloidosis

Discussion:

AL amyloidosis is a systemic plasma cell dyscrasia. While it can involve several organs, characteristic dermatologic findings include: periorbital purpura (raccoon eyes) with minimal or no trauma despite normal coagulation studies, ecchymoses, subcutaneous nodules and/or plaques, and waxy skin thickening.