Can You Identify the Cause of These Puzzling Symptoms?

摘要

A 72-year-old man slipped and fell backward in the bathroom, hitting his head on the toilet seat; he suffered only minimal discomfort. The following day, he presented with mild back pain and extensive bruising.Impressive ecchymoses extended from his left flank to his right flank, across the midline, where a tender mass was palpated. Swelling was visible from a distance at the L4 level; the 17 x 10-cm lesion was raised approximately 1.5 cm, with overlying black-blue ecchymoses. The patient was taking self-prescribed baby aspirin, 81 mg/d; vitamins C, E, and B12; and Ginkgo biloba, 400 mg/d.