Psychogenic purpura

The image shows a bruise on the left lateral thigh of a 48-year-old woman with a one-year history of spontaneous skin bruising associated with skin stinging, popping, and pulsating sensation. This lesion had appeared 16 hours earlier. Petechiae and multiple ecchymoses seen in the image were nonpalpable but tender. Extensive workup for a bleeding disorder was negative. Skin biopsies of areas involved with bruises showed a mild perivascular granulocytic infiltrate around dermal capillaries but no frank vasculitis. There was a striking absence of erythrocyte extravasation.