Spontaneous Bruising in Elderly Diabetic Patient

Case at a Glance

A 65-year-old female with well-controlled type 2 diabetes mellitus and thyroid disorder presents with a 6-month history of spontaneous bruising on bilateral upper extremities without apparent trauma or lifestyle changes.

Patient's Story

The patient began noticing multiple bruises appearing on her arms approximately 6 months ago without any identifiable cause. She denies any changes in her daily routine, medication regimen, or physical activity level. The bruises typically appear overnight, with the patient discovering new lesions upon awakening. She maintains that she is not prone to accidents and does not recall any trauma that could account for the bruising pattern. The patient takes sleeping medication and reports sleeping soundly without significant movement during the night. She denies experiencing pain associated with the bruises.

Initial Assessment

Physical examination revealed multiple purpuric lesions of varying ages distributed across both upper extremities. The patient appeared well-nourished and in no acute distress. Her diabetes and thyroid conditions were reportedly well-controlled based on recent laboratory results. Current medications include aspirin and sleeping medication, with the patient denying use of anticoagulants or other medications known to increase bleeding risk.

The Diagnostic Journey

Initial consultation with primary care physician resulted in attribution of bruising to nocturnal trauma during sleep, though this explanation was inconsistent with the patient's sleep patterns and the distribution of lesions. Given the spontaneous nature and characteristic appearance of the bruises, differential diagnosis included medication-induced bleeding, platelet disorders, vascular fragility, and age-related skin changes.

Final Diagnosis

Clinical presentation consistent with actinic purpura (solar purpura), a common benign condition in elderly patients characterized by spontaneous bruising due to age-related capillary fragility and chronic sun exposure effects on the skin.

Treatment Plan

Patient education regarding the benign nature of actinic purpura was provided. Recommendations included gentle skin care, sun protection to prevent further photodamage, and monitoring for any changes in bruising patterns. Review of current medications to ensure no unnecessary bleeding risk factors.

Outcome and Follow-up

Patient was reassured about the benign nature of the condition. Scheduled for routine follow-up to monitor bruising patterns and ensure no development of concerning features that might suggest alternative diagnoses requiring further investigation.