A 57-year-old Chinese man presented with progressive, petechial rashes over both lower limbs for 6 months. Systemic review was unremarkable. His past medical history was significant for deep venous thrombosis of the lower limb, which was previously treated with antico-agulation a decade ago. He was otherwise well and was not on any long-term medications. He had seen multiple doctors and was treated with oral ketoconazole, antihis-tamines and topical corticosteroids - the rashes had progressed despite all these therapies. The patient had most recently consulted a dermatologist who diagnosed him with pigmented purpuric dermatosis (PPD), a typically benign condition.
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