Figure legend:
Figure 1: Non-blanching violaceous rash at initial presentation. Rash was convalescent on the lower two-thirds of the face (a), and macular over the trunk (b). Rash resolved completely after the first cycle of induction chemotherapy. Her family provided consent to publish these images. Photograph credit: Suhas Radhakrishna.
Figure 2: Diagnostic workup included CT of the neck, chest, abdomen, and pelvis and PET/CT. CT scan, identified the liver 17 cm in superior to inferior dimension without focal lesion and spleen 24 cm in superior to inferior dimension. Spleen was diffusely heterogeneous in attenuation with several large geographic areas of hypoattenuation. No additional areas of lymphadenopathy were identified (a). PET/CT was significant for massive splenomegaly with portions of the spleen intensely hypermetabolic with Deauville Score 5 (b).