Emergency Medicine Case Challenge: Bleeding Gums and Rash on Both Legs in a 38-Year-Old Man

Basma Abdulhadi, MD


April 12, 2023

Editor's Note:
The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to recognize accurately. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a Case Challenge, please contact us.


A 38-year-old man with no known past medical history presents to the emergency department with a 3-day history of bleeding from his gums. The patient reports having a small amount of blood oozing from his gums after brushing his teeth over the past couple of days and noticed some "red/bloody" blisters in his mouth. He noticed spontaneous minimal bleeding today, which prompted him to present to the emergency department. He also noticed a rash on both of his legs over the past couple of weeks (Figure 1).

Figure 1.

He describes the rash as flat pinpoint red lesions that do not bleed or blanch with pressure. He denies any history of trauma to his legs or face and reports only becoming concerned when his mouth started bleeding today.

He denies having bleeding elsewhere and has no hematuria, melena, or hematochezia. He also denies any headaches, fevers, chills, recent illnesses, abdominal pains, or urinary symptoms. He has no personal or family history of bleeding disorders. He denies nicotine use, excess alcohol use, and drug abuse. He denies having any medical conditions and denies taking any recent medications. His family history is significant for hypertension and diabetes in his father.


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