Thank you to Kenny Petterson for finishing intern year STRONG with an amazing morning report case. He presented a 45 y/o man with diabetes who presented with multisystem organ failure and a petechial rash.
Ground glass opacities
Ddx of ground glass opacities in the lung
- Water (pulmonary edema)
- Pus (infection, inflammation)
- Blood (diffuse alveolar hemorrhage)
Now lets talk purpura.
This is an opportunity to highlight some amazing resources from the UCSF dermatology department: the dermatology glossary and the purpura/petechiae online module. Go to the dermatology glossary to demystify specific skin terms. The online modules give you a case-based deep dive into specific dermatologic disorders.
Purpura are defined as red-purple skin lesions that result from blood extravasation into tissue. They are non-blanching. Morphologically they are divided into
Palpable
- A sign of vascular inflammation or damage, usually a small or medium vessel vasculitis
- Palpable purpura is the hallmark of a leukocytoclastic vasculitis, but LCV is a histopathologic diagnosis
- Ddx
- Primary rheum
- ANCA-associated
- Cryoglobuinemic vasculitis
- Polyarteritis nodosa
- Henoch-schonlein purpura (rare in adults)
- Urticarial vasculitiS
- SLE
- Primary rheum
- Infection
- HBV-associated PAN
- HCV associated cryoglobulinemia
- Purpura fulminans associated with DIC
- Malignancy-related
- Medication effect (meds can cause an LCV on their own!)
- CBC w platelets
- ESR/CRP
- ANA
- ANCAs
- Complements
- UA
- Infectious w/u including HIV, HCV, HBV, +/- ASo or strep throat culture and cryos
- Usually noninflammatory
- further subdivided by size
Petechiae <3mm in size
- Ddx
- Qualitative and quantitative platelet disorders
- DIC and infection (mycoplasma was a strong consideration in our case today)
- Increased intravascular venous pressure (due to clot or obstruction)
- Inflammatory skin disease
- Increased vascular fragility including d/t vitamin deficinecies like scurvy
Ecchymosis >5mm in size
- External trauma
- DIC and infection
- Coagulopathy
- Skin weakness/fragility
- Waldenstrom’s
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