Another Monday means another medical mystery for you to solve. Have fun guessing the diagnosis!
A 73 year old woman goes to her doctor because her gums have been bleeding lately. She tells the doctor she has always had good dental health and taken good care of her teeth, but she has noticed this change over the past several months. She reports that she hasn’t been eating anything out of the ordinary lately, and she has no history of excessive bleeding. The patient has also been feeling more tired than usual lately with some aches and pains that feel deep within her muscles and bones, even though she is retired and does not live a strenuous lifestyle. When asking about her social history, the doctor finds out she lives alone (her husband died last year) and she smokes a half pack of cigarettes each day. She has no other major medical problems.
During the physical exam, the doctor notices she is a pale, thin, frail woman. He examines her gums (shown below), and finds they are swollen and bleed easily. He also notes she has some red spots from burst blood vessels on the inside of her mouth and throat. The doctor notices some bruising on both legs, but the patient does not remember bumping in to anything or falling. He also sees the red, bumpy lesions shown below on the skin overlying her ankles.
What is the most likely diagnosis?