Can You Identify the Cause of These Puzzling Symptoms?

Abdominal Ecchymosis

Left-sided abdominal pain of 5 days' duration and the recent appearance of purplish discoloration on the abdomen prompt a 58-year-old woman to seek emergent medical care. She has also had a severe nonproductive cough for 2 months. The patient does not have diabetes, and she has not received the influenza or pneumococcal vaccines. She denies alcohol(Drug information on alcohol) use. Other physical examination findings are unremarkable.