A 70 year old man with a 6-year history of generalized lymphadenopathy, hepatosplenomegaly, hypogammaglobulinemia and recurrent pulmonary infections, undergoing chemotherapy with monthly courses of chlorambucil-methylprednisolone. Four months earlier he became anemic (Ht 24%, reticulocytes 185.000/μL). In the last 3 months he developed a confluent palpable rash on the interior surface of the leg ranging from purple patches in the early lesions to red-brown-blue macules or nodules in the older lesions, with rapid extension. The nodules had a large base and bled easily. The lesions were non-pruritic and painful and the adjacent skin was red and swollen.