Sir,
Pigmented purpuric dermatoses (PPD) are a group of disorders which have histopathologically similar but morphologically different appearance. The five main clinical subtypes of PPD has been described. The perivascular lymphocytic infiltration of superficial dermal vessels with extravasations of red blood cells are common histopathological characteristics for all types of PPD. The etiopathogenesis of disease remains obscure yet [
A 52-years-old man presented with asymptomatic skin eruption that had been present for two months. The patient had a history of oral diclofenac sodium intake ten days before the lesions appeared. He also had hepatitis B infection recognized at childhood and he had been followed by gastroenterology department with regular interval. The physical examination revealed several, symmetrical, nonpalpable, nonblanchable, erythematous, annular purpuric patches with a peripheral rim of dark red telangiectatic puncta distributed symmetrically on the upper legs and inguinal areas. The annular patches showed central clearing with minimal hyperpigmentation and atrophy (
(A) Symmetrical, nonblanchable, erythematous, annular purpuric patches with central clearing and minimal hyperpigmentation and atrophy on the left and (B) inner side of upper leg.
The laboratory investigations were within normal limits except hepatitis B antigen positivity. The histopathological examination revealed a moderately bandlike infiltration accompanying a prominent perivascular lymphocytic infiltration in superficial dermis. There was no evidence of vasculitis (Figs.
(A) A moderately bandlike and prominent perivascular lymphocytic infiltration in superficial dermis. (H&E, ×100), (B) The closer view of infiltration, the pseudovasculitis appearence of lymphocytic infiltration encircling vessels without fibrin deposition (H&E, ×200), (C,D) The presence of blue coloured hemosiderin within the papillary dermis freely or in macrophage system (Prussian blue, ×40).
PATM is an uncommon clinical variant of pigmented purpuric dermatosis [
A wide variety of medications including NSAIDs, diuretics, sedatives, stimulants antibiotics, cardiovascular drugs, vitamins, antihyperglycemics, isotretinoin have been implicated as drugs responsible for the development of PPD [
We intended to present this case because of the rarity of the PATM and it should be kept in mind that diclofenac sodium could play role in etiopathogenesis.