A 78-Year-Old Woman With Nonpruritic Periorbital Purpura Around Her Eyelids

Poll

A 78-year-old woman suffers from seasonal rhinitis and conjunctivitis. For the first time, however, she now notes the striking appearance of painless and nonpruritic periorbital purpura involving areas where she has rubbed her itchy eyelids. The patient denies ingestion of aspirin, other NSAIDs, or anticoagulants. Past medical history discloses a distant episode of left-sided lobular breast cancer (ostensibly cured), chronic low back pain managed by taking narcotic analgesics as needed, and several bouts of mild depression.

Which statement is true regarding her present eye condition?

A. This most likely represents a chronic allergic reaction and requires ongoing installation of ocular corticosteroids.
B. This most likely represents bilateral periorbital cellulitis and requires hospitalization for IV antibiotic administration.
C. This could be a multiple myeloma manifestation. Serum, urine, and radiologic investigations should be done after skin biopsy.
D. This pattern strongly suggests metastatic osteosarcoma, and an emergent bone scan should be considered.

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