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A 53-year-old woman with a background of chronic bronchitis was admitted with an infective exacerbation of chronic obstructive pulmonary disease. Her medical history included atrial septal defect (ASD) and ventricular septal defect (VSD) repair in childhood and a recent deep vein thrombosis, for which she was on rivaroxaban. On examination, she had multiple blue pigmented soft tissue lesions on her face, tongue, torso and hands (figures 1 and 2).
During her admission, the patient developed melaena associated with a significant acute drop …