Granulomatous pigmented purpuric dermatosis (PPD) is a rare subtype of pigmented purpuric dermatosis that is typically seen in women of Far East Asian descent on the distal lower extremities and feet. Granulomatous PPD is a benign condition that does not typically require treatment. Hyperlipidemia has been seen in over half of the eighteen cases reported in the literature. We report an unusual presentation of granulomatous PPD seen in a 71 year-old Caucasian female with hyperlipidemia.