A 58-year-old man presents with a 2-year history of eyelid lesions, fatigue, and ‘Raccoon eyes’. Explore the diagnosis behind these classic signs.
A 58-year-old man presented to the dermatology clinic with a 2-year history of eyelid lesions and with weight loss and fatigue over the past several months. On physical examination, scattered periorbital petechiae and purpura were noted, as well as coalescing, waxy papules on the eyelids. Macroglossia was also present. Serum coagulation tests were normal. A biopsy of the left upper eyelid resulted in ecchymosis. What is the most likely explanation for the spontaneous periorbital petechiae and significant bruising after the biopsy in this case?
What is the most likely diagnosis?
AL amyloidosis, Macroglossia, Periorbital purpura, Raccoon eyes, Vascular fragility owing to infiltration of vessel walls
