Persistent pigmented purpuric lesions in a 14-year-old adolescent.

We present the case of a 14yearold girl with a macular, bilateral, pigmented purpuric lesions onto the lower part of legs, that had appeared three weeks prior to the time of admission in the Pediatric Department II of the “Sf. Maria” Emergency Clinical Hospital for Children, Iaşi, Romania, apparently after an upper respiratory tract infection. The clinical features included the extended, irregularly shaped patches of purpura and purpuric papules on the posterior area of both legs, which eventually formed a large eruption. The differential diagnosis ruled out at the time an allergic rash, an autoimmune vasculitis, and also an infectiousinduced rash. The laboratory tests were within normal range (inflammatory, immunologic and serologic markers). The positive diagnosis was outlined by the histopathological analysis, that revealed focally perivascular inflammatory infiltrates consisting of lymphocytes and conspicuous extravasation of red blood cells, mainly in the papillary and reticular dermis. The immunohistochemical analysis was positive for CD45 in the perivascular areas, also with CD3positive cells in the inflammatory infiltrate. We noted the presence of the CD68 in macrophagic cells, especially in the profound layers of the skin. These histological findings were consistent with pigmented purpuric dermatosis, therefore the eruption was diagnosed as pigmented purpuric dermatosis (a rare pathology especially in children), based on clinically purpuric pigmented lesions and the histological findings. [ABSTRACT FROM AUTHOR]