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A 60-year-old man presented with progressive exertional dyspnoea and swelling in the bilateral lower limb. His relatives noted discolouration around the eyes over the last 6 months. He had a history of easy bruisability and noticed spontaneous ecchymotic patches for a couple of years with no other significant bleeding manifestations. On physical examination, he was noted to have bilateral periorbital ecchymosis with normal sclera (figure 1), raised jugular venous pressure with prominent a waves and x …
Contributors All the authors have contributed significantly to planning, conduct, and reporting of the work. PGS identified the case. All authors take full responsibility for working up the case, writing the manuscript and editing the images.
Competing interests None declared.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.