A 73-year-old woman with untreated multiple myeloma presented with new-onset periorbital purpuric, nonblanching, nonpruritic lesions. The lesions appeared spontaneously and were not associated with any recent trauma. She did not take aspirin, nonsteroidal antiinflammatory drugs, or any other anticoagulant agents.
On physical examination, no similar skin lesions were found elsewhere. In addition, laboratory studies revealed mild impairment of renal function and nephritic-range proteinuria. The blood count showed mild thrombocytopenia (platelet count, 80,000 per cubic millimeter), whereas the prothrombin time and partial-thromboplastin time were normal.
What is the diagnosis ?
a) Orbital fracture
b) Disseminated intravascular coagulation
c) Tuberous sclerosis
d) Amyloid purpura
e) Horner’s syndrome
