Paintball Purpura: The Ball Sports-induced Targetoid Erythema (SITE) Sign Revisited

The ball sports-induced targetoid erythema (SITE) sign is a term that refers to annular erythematous lesions surrounding normal skin that occur after ball to skin contact. Associated purpura may be present or absent. A 19-year-old college student presented with multiple purpuric lesions of targetoid appearance. Additional history revealed that the lesions corresponded with the areas of ball contact during a paintball game. Similar lesions have been described in the participants of other sports, including floorball, ping pong, racquetball, and squash. When evaluating a patient with targetoid erythema with or without accompanying purpura, additional history of recent participation is an activity involving a high-velocity ball may be useful for establishing the diagnosis of the ball SITE sign.