RT Journal
A1 Ahluwalia J, Shah KN, Castelo-Soccio L
T1 PIcture of the month—quiz case
JF JAMA Pediatrics
JO JAMA Pediatrics
YR 2013
FD February 1
VO 167
IS 2
SP 185
OP 185
DO 10.1001/jamapediatrics.2013.938a
UL http://dx.doi.org/10.1001/jamapediatrics.2013.938a
AB 
A 15-year-old girl presented to the office with a 3-day history of dark-purple and tender plaques on her lateral thighs and buttocks that were increasing in number (Figure 1 and Figure 2). Many appeared to be necrotic. This patient had a history of protein S deficiency diagnosed after a pulmonary embolism 1 year before presentation and was undergoing long-term anticoagulation therapy with warfarin. She stopped taking the warfarin as prescribed 2 to 3 weeks prior to presentation and when it was noted that she had a subtherapeutic international normalized ratio, the patient restarted warfarin. A punch biopsy of a representative plaque on the lateral thigh was performed and confirmed the diagnosis.