[Reprinted from Journal of Cutaneous and Genito-Urinary Diseases, Vol. V., Oct., 1887,] 
A CASE OF PURPURA WITH CIRCINATE LESIONS* 
BY 
HENRY W. STELWAGON, MD., 
Physician to the Philadelphia Dispensary for Skin Diseases, and to the Skin Department of 
the Philadelphia and Howard Hospitals. 
IN the early part of last April there applied at the service of the 
Philadelphia Dispensary for Skin Diseases a male adult regarding 
an eruption which had appeared some time previously, and through 
the persistence of which the man had been finally led to seek advice. 
The patient was forty-four years of age, strong and robust. On ex- 
amination the trunk, and, to a slight degree, the upper parts of the 
arms and thighs, were found to be the seat of a peculiar eruption. The 
lesions were macular, without elevation, of a reddish purple and bluish 
color, and the greater number of annular form. Here and there could 
be seen small pin-head to small pea-sized simple macules; those of 
larger area were ring-shaped, the central part of a faint bluish or dark 
tint, and the border, from one to several lines in width, of a reddish or 
a reddish-blue color. TTpon careful investigation all stages from tlie 
plain macule to the perfectly formed ring could be seen. The de- 
veloped lesions, those about the size of a dime, were most conspicuous, 
the color being of a purplish blue shade. While many of the advanced 
lesions were almost perfectly annular, many also were irregularly 
rounded, and in places several had merged and given rise to larger 
patches with tortuous margins. The eruption existed in greatest pro- 
fusion upon the anterior part of the trunk, across and above the epi- 
gastric region. There were few spots on the upper part of the arms 
and thighs. The lesions from beginning to end were of a hemor- 
rhagic nature, there being no preceding or accompanying hypersemia. 
*Read at the 11 th annual meeting of the American Dermatological Associa- 
tion, September 1, 1887. According to the statement of the patient, the eruption had first ap- 
peared as small round spots of a reddish or orange-red color, about 
three months previously just above the umbilicus and then gradually 
extended. As the spots became the size of a small pea the centre began 
to disappear, and in this manner the type of the eruption had become 
circinate. There were no subjective symptoms, and apparently, and so 
far as the patient himself knew, his general health was good. The case 
remained under notice about two weeks, at intervals of a day or two, 
and in this time the course of the lesions was noted to be the same as 
the man had described. The patient then ceased his visits to the dis- 
pensary and was not seen until four months later-the middle of last 
month (August). An examination disclosed the fact that the eruption 
had almost disappeared; here and there, over the upper part of the 
abdomen traces being seen in the form of irregular, serpentine, faint 
bluish lines or bands. In all the process had lasted eight or nine 
months. 
The literature, so far as a somewhat hasty search shows, records but 
one case of a similar nature-a case reported by Drs. Duhring and Van 
Harlingen in the Medical and. Surgical Reporter of August 3, 1878. 
In their case the eruption was confined to the legs, and the annular 
form was not noted until seven months after the disease first appeared; 
in the case just reported, the eruption was practically limited to the 
trunk, and the lesions from the start tended to become rapidly of the 
circinate type. 
1411 Spruce Street, Philadelphia., Journal of Cutaneous 
and 
Genito-Urinary Diseases, 
Oct., 1887. 
CASE OF PURPURA WITH CIRCINATE LESIONS.