A 43-year-old male with a history of hypertension, diabetes and obesity (BMI > 55) presented to the Emergency Department with a pruritic palpable rash for several days. It had started suddenly as erythematous wheals on the inguinal folds and spread turning into a generalized purpura, with a clear predominance on the distal aspect of legs. The presence of subcutaneous edema was impossible to assess, and no other primary lesions were present on skin or mucous membranes. The rash associated intense pruritus and general fatigue without fever.
