A fourteen-year-old girl came with a history of developing large black and blue spots on her arms, thighs, and abdomen. There was no pattern to the lesions, nor could we elicit a monthly or seasonal cycle. The girl denied any symptoms of itch, tenderness or pain. She would awaken to find new ones, which then slowly faded away with a bluish, at times yellowish, color. Her parents were mystified. She had seen a hematologist, whose studies on her showed normal bleeding and clotting functions. She had plenty of platelets so essential in keeping the blood within the blood vessel walls. There was no evidence of an eating disorder which could cause scurvy from vitamin C deficiency. She did not have the black and blue spots of the thin skin of the aged. And, she did not participate in any bruising sports.

A detailed history was essential. We recalled the hurried Monday office visit of a patient worked in as an emergency after she had suddenly developed dozens of black and blue spots. We rushed her to the laboratory before closing time for a complete (and expensive) battery of blood studies. We called for the results of our “stat” bloods only to hear the technician say, “You mean the results on that patient with all the black and blue spots from white water rafting yesterday? They are normal.”