Periorbital ecchymosis secondary to severe coughing: a valsa
The present case has been reported in the Indian Dermatology Online Journal.

A 70-year-old woman presented with chief complaints of sudden onset of asymptomatic red-colored lesions over the periorbital region since the previous night. There was no history of insect bite, trauma, fever, or bleeding from any site. Patient was a known case of asthma and there was a history of increase in the severity of coughing with nocturnal exacerbation for 1 week.

On systemic examination, rhonchi were present in the bilateral lung fields. On dermatological examination, well-defined, ecchymotic patch was present in the left periorbital area extending vertically from the brow to 1 cm below the lower eyelid and horizontally from the side of the nose to the left temple area with involvement of tarsal plate of eyelid medially.

A similar well-defined, oval ecchymotic patch of size 3 × 2cm was present on the medial canthus of the right eye. Ophthalmological examination was unremarkable.

Routine investigations including complete hemogram, bleeding time, prothrombin time and activated partial thromboplastin time, liver and renal function tests, and serum electrophoresis were normal. CT and MRI of the brain were normal with no evidence of skull base fracture, and there was no abnormality in the intracranial or periorbital vasculature.

Based on the above mentioned findings and in the absence of any underlying coagulation disorder, the diagnosis of periorbital ecchymosis secondary to severe coughing was made. Patient was advised a topical emollient and asked to follow-up after 2 weeks.

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