Malignant Melanoma of Unkown Origin Presenting as a Systemic Vasculitis

Several conditions present mimicking systemic vasculitis, such as atrial myxomas, subacute bacterial endocarditis, and cholesterol emboli. While vasculitis associated with malignancy has been described,1tumor emboli producing vasculitislike lesions have not been well defined. We present a patient in whom ischemic toes and livedo reticularis with palpable purpura developed. A skin biopsy specimen demonstrated extensive dermal intravascular fibrin thrombi with neutrophilic leukocytoclasia corresponding to foci of tumor emboli. Report of a Case. Our patient was a 66-year-old white man who presented with a mottled erythematous eruption of both lower extremities and cyanosis of his toes. Ten days before admission, pruritis developed on his feet that progressed to burning, cyanosis, and a patchy erythema from his umbilicus to his feet. Findings from his physical examination revealed purpuric lesions and livedo distal to the umbilicus (Figure 1) Blood studies were remarkable for a white blood cell count of 18.4×10/9/L.