Pinch Purpura: A Clinical Clue to Primary Systemic Amyloidosis

A 58-year-old male presented with multiple purpuric and ecchymotic macules over his face, neck, and behind ears along with macrochelia for 1 month [Figure 1]. Routine investigations revealed anemia, proteinuria, and hypercalcemia. Serum protein electrophoresis showed lambda light chain with positive Bence Jones protein on urinalysis. Bone marrow aspiration biopsy confirmed a plasma cell neoplasm. Finally, the patient was diagnosed with primary systemic amyloidosis secondary to plasma cell neoplasm and was referred to hematology department for further management.Figure 1: Bilateral periorbital swelling, large ecchymotic patches over the forehead, both eyes along with purpuric macules over lips and macrocheiliaClinical presentation of bilateral periorbital purpuric macules with or without macroglossia or macrocheilia should be evaluated for primary systemic amyloidosis.[1,2] Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.