This patient is a 48-year-old white male complaining of a history of petechial lesions on the bilateral lower extremities and a 2 week history of swelling and pain in the right ankle. He denies any history of trauma, bites, tick exposure, or new medications. Additional findings are significant for submucosal hemorrhage of the oral mucosa gingival hypertrophy with bleeding gums.

Petechiae are elementary lesions, where they are considered red spots without relief due to blood extravasation, where the blood spills to the extravascular environment.

On the other hand, this phenomenon usually occurs in gums and skin when the condition is systemic and not due to a local phenomenon.

Explanation:

Petechiae can occur due to diseases such as scurvy, which is a deficiency of vitamin C which generates capillary fragility due to alteration of collagen formation.

Chronic administration of corticosteroids in the long term, thus generating fragility of the capillary wall.

Or finally, it could become a malignant disease such as leukemia or kaposi's sarcoma, where cell metaplasia generates these lesions accompanied by spontaneous hemorrhages in the oral mucosa.