Diffuse Reticulate Purpura in an Adolescent Female With Anorexia Nervosa: A Case Report

Diffuse reticulate purpura (DRP) is a rare, visually striking cutaneous manifestation of severe malnutrition and has been reported in a handful of adolescents with anorexia nervosa. We describe a case of DRP in a 13-year-old female with anorexia nervosa, marking one of the few documented cases in a female patient. She presented with a net-like, violaceous purpuric rash across her trunk and back following several months of significant weight loss, driven by restrictive eating and excessive exercise. Her examination otherwise revealed marked cachexia and bradycardia, without signs of trauma. Laboratory findings were notable for leukopenia, electrolyte disturbances, transaminitis, and early signs of refeeding syndrome; there was no evidence of coagulopathy. Dermatology consultation confirmed DRP, which resolved rapidly with nutritional rehabilitation. This case highlights DRP as a reversible dermatologic indicator of severe malnutrition, likely resulting from microvascular and connective tissue compromise from protein and fat depletion. Recognition of DRP may help prevent unnecessary investigations for hematologic or vasculitic conditions. Increased clinician awareness is essential, as DRP may serve as a visible marker of critical nutritional compromise. Further research is needed to clarify the pathophysiology, sex distribution, and clinical implications of DRP in eating disorders.