1
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Drivenes JL, Bygum A. Rettelse: Golfspillerens purpura. Tidsskr Nor Laegeforen 2024; 144:24-0262. [PMID: 38738575 DOI: 10.4045/tidsskr.24.0262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2024] Open
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2
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Myers H, Ceci FM, Rupley K, Roberts M. Excimer Laser Therapy for Pigmented Purpuric Dermatosis: A Case Study. Am J Case Rep 2024; 25:e942853. [PMID: 38698617 DOI: 10.12659/ajcr.942853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
BACKGROUND Pigmented purpuric dermatosis (PPD) is a rare disease that is poorly understood but thought to result from inflammation of the capillaries causing extravasation of erythrocytes into the soft tissue. There are a variety of potential causes, including medications, such as acetaminophen and aspirin, abnormal humoral immunity, and excessive exercise. Although benign, PPD can be bothersome to patients due to associated pruritus, weeping, and poor cosmetic results. Treatment of this lesion is difficult, with no standardized regimen and a tendency for relapse once treatment is discontinued. CASE REPORT This case reports on a 77-year-old man who presented to an outpatient dermatology clinic with bilateral lower extremity edema with associated weeping and erythema for 1 year. A biopsy was conducted and resulted as PPD. He began treatment with excimer laser therapy after conservative and topical treatment options failed, with resolution of symptoms without recurrence for approximately 1 year. CONCLUSIONS PPD is notoriously difficult to treat, and historic treatment options include topical corticosteroids, oral supplements, and immunomodulators, all of which come with a range of adverse effects. However, new literature supports the use of phototherapy to treat PPD, with varying results. Previously implemented options include but are not limited to phototherapy with psoralen plus ultraviolet A, narrow band ultraviolet B, advanced fluorescence technology pulsed light, and fractional non-ablative 1540-nm erbium: glass laser, each with varying degrees of success. This case discusses the successful treatment of recalcitrant PPD with excimer laser therapy and maintenance of remission for approximately 1 year.
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Affiliation(s)
- Hannah Myers
- Department of Dermatology, Medical College of Georgia, Augusta, GA, USA
| | - Francesca M Ceci
- Department of Dermatology, Philadelphia College of Osteopathic Medicine, Atlanta, GA, USA
- Department of Dermatology, Goodman Dermatology, North Fulton Hospital, Roswell, GA, USA
| | - Katherine Rupley
- Department of Dermatology, Goodman Dermatology, North Fulton Hospital, Roswell, GA, USA
| | - Michael Roberts
- Department of Dermatology, Goodman Dermatology, North Fulton Hospital, Roswell, GA, USA
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3
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Ninkov T, Bui J, Raby E, Wood BA, Mesbah Ardakani N. A rare case of unique purpuric circular eruption in association with Capnocytophaga canimorsus bacteremia. Australas J Dermatol 2024; 65:e72-e74. [PMID: 38421882 DOI: 10.1111/ajd.14242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 02/13/2024] [Accepted: 02/16/2024] [Indexed: 03/02/2024]
Affiliation(s)
- Tatiana Ninkov
- Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Justin Bui
- Fiona Stanley Hospital, Murdoch, Perth, Western Australia, Australia
| | - Edward Raby
- Fiona Stanley Hospital, Murdoch, Perth, Western Australia, Australia
| | - Benjamin Andrew Wood
- Department of Anatomical Pathology, PathWest, QEII Medical Centre, Perth, Western Australia, Australia
| | - Nima Mesbah Ardakani
- Department of Anatomical Pathology, PathWest, QEII Medical Centre, Perth, Western Australia, Australia
- School of Medicine, The University of Notre Dame, Fremantle Campus, Fremantle, Western Australia, Australia
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4
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DeSena G, Yi L, Singh A, Sande M, Bryer B. A 12-year-old boy with petechiae, arthralgias, and muscle weakness. Pediatr Dermatol 2024; 41:531-533. [PMID: 38291991 DOI: 10.1111/pde.15535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 01/07/2024] [Indexed: 02/01/2024]
Affiliation(s)
- Grace DeSena
- University of Florida College of Medicine, Florida, USA
| | - Lauren Yi
- Department of Dermatology, University of Virginia, Virginia, USA
| | - Amrit Singh
- Department of Pathology, University of Virginia, Virginia, USA
| | - Margaret Sande
- Department of Emergency Medicine, University of Virginia, Virginia, USA
| | - Bridget Bryer
- Department of Dermatology, University of Virginia, Virginia, USA
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5
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Drivenes JL, Bygum A. Golfer's purpura. Tidsskr Nor Laegeforen 2024; 144:23-0604. [PMID: 38651721 DOI: 10.4045/tidsskr.23.0604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024] Open
Affiliation(s)
| | - Anette Bygum
- Syddansk Universitet, og, Hudklinikken i Kolding
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6
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Shichijo Y, Horiuchi K, Fogel J. Immune thrombocytopaenic purpura following COVID-19 infection masquerading as senile purpura. BMJ Case Rep 2024; 17:e259747. [PMID: 38627048 PMCID: PMC11029321 DOI: 10.1136/bcr-2024-259747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024] Open
Affiliation(s)
- Yuka Shichijo
- Medicine, Mount Sinai Beth Israel, New York, New York, USA
| | - Kohei Horiuchi
- Medicine, Mount Sinai Beth Israel, New York, New York, USA
| | - Joyce Fogel
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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7
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Avallone G, Vocino Trucco G, Roccuzzo G, Conti L, Lanzarone G, Orlando G, Agostini A, Giunipero di Corteranzo I, Astrua C, Quaglino P, Ribero S. Mixed purpuric and maculopapular eruption in a 70-year-old woman. Clin Exp Dermatol 2024; 49:430-433. [PMID: 37995288 DOI: 10.1093/ced/llad407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 11/04/2023] [Accepted: 11/14/2023] [Indexed: 11/25/2023]
Abstract
A 70-year-old woman presented with diffuse mixed purpuric and erythematous maculopapular lesions that spared the folds. Histological examination revealed a discrete perivascular and interstitial lymphocytic infiltrate with a monomorphic appearance in the dermis.
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Affiliation(s)
| | | | | | - Luca Conti
- Pathology Unit, Città della Salute e della Scienza University Hospital, Turin, Italy
| | - Giuseppe Lanzarone
- Department of Molecular Biotechnology and Health Sciences, Division of Hematology
| | - Giulia Orlando
- Department of Oncology, University of Turin, Turin, Italy
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8
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Drivenes JL, Bygum A. Spontaneous Oral Purpura in Immune Thrombocytopenia. N Engl J Med 2024; 390:1029. [PMID: 38477990 DOI: 10.1056/nejmicm2312260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
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9
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Novotny RW, Trinh LN, Gowan AJ, Lomeli MC. Palpable Purpura. Am Fam Physician 2024; 109:265-267. [PMID: 38574218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Affiliation(s)
| | - Lien N Trinh
- AltaMed Family Medicine Residency Program, Los Angeles, California
| | - Amy J Gowan
- AltaMed Family Medicine Residency Program, Los Angeles, California
| | - Matthew C Lomeli
- AltaMed Family Medicine Residency Program, Los Angeles, California
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10
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Jabbour AJ, Mannava K, Farah RS, Farah J. Painful Retiform Purpura in a Peritoneal Dialysis Patient. Cutis 2024; 113:E9-E11. [PMID: 38593101 DOI: 10.12788/cutis.0958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Affiliation(s)
- Austin J Jabbour
- Drs. Jabbour, R.S. Farah, and J. Farah are from SUNY Upstate Medical University, Syracuse, New York. Dr. Mannava is from the University of Rochester, New York
| | - Kathleen Mannava
- Drs. Jabbour, R.S. Farah, and J. Farah are from SUNY Upstate Medical University, Syracuse, New York. Dr. Mannava is from the University of Rochester, New York
| | - Ramsay S Farah
- Drs. Jabbour, R.S. Farah, and J. Farah are from SUNY Upstate Medical University, Syracuse, New York. Dr. Mannava is from the University of Rochester, New York
| | - Joyce Farah
- Drs. Jabbour, R.S. Farah, and J. Farah are from SUNY Upstate Medical University, Syracuse, New York. Dr. Mannava is from the University of Rochester, New York
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11
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MacLean D, Shaw J. Petechial Rash Distal to a Radial Artery Compression Device. J Gen Intern Med 2024; 39:331-333. [PMID: 37940755 PMCID: PMC10853088 DOI: 10.1007/s11606-023-08521-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 10/30/2023] [Indexed: 11/10/2023]
Affiliation(s)
- Davis MacLean
- Department of Medicine, University of Calgary, Calgary, Canada.
| | - Jeffrey Shaw
- Libin Cardiovascular Institute, Department of Cardiac Sciences, University of Calgary, Calgary, Canada
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12
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Chantrapitak J, Chuamanochan M. Papular-Purpuric "Gloves and Socks" Syndrome in Parvovirus B19 Infection. N Engl J Med 2024; 390:165. [PMID: 38197819 DOI: 10.1056/nejmicm2309953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
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13
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Sekizawa A, Nagano A, Hashimoto K, Ono Y. Conjunctival petechiae in infective endocarditis. Cleve Clin J Med 2024; 91:20-21. [PMID: 38167396 DOI: 10.3949/ccjm.91a.23041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Affiliation(s)
- Akinori Sekizawa
- Department of General Medicine, National Defense Medical College, Saitama, Japan
| | - Ayaka Nagano
- Department of Cardiology, National Defense Medical College, Saitama, Japan
| | - Kenichi Hashimoto
- Department of General Medicine, National Defense Medical College, Saitama, Japan
| | - Yosuke Ono
- Department of General Medicine, National Defense Medical College, Saitama, Japan
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14
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Sun J, Liu K, Dang J, Xiong S, Pan H, Wang Y. Pigmented purpura dermatosis-like mycosis fungoides: four case reports and a review of published cases. Eur J Dermatol 2023; 33:635-641. [PMID: 38465544 DOI: 10.1684/ejd.2023.4574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Mycosis fungoides (MF) is the most prevalent type of cutaneous T-cell lymphoma and is generally characterized by multiple patches or plaques with fine scales. One of its variants manifests with multiple purpuric eruptions, mimicking benign pigmented purpuric dermatosis (PPD). To investigate clinicopathological features of PPD-like MF patients. We report four PPD-like MF cases and summarize the clinicopathological features described in reports of nine PPD-like MF cases published in the past 20 years. Compared with benign PPD, petechial lesions in PPD-like MF are more generalized, persistent, and resistant to conventional steroid treatment. Histologically, a superficial dermal band-like infiltrate of atypical lymphocytes with epidermotropism seems to be the most common feature of PPD-like MF. A lymphoid phenotype of CD4+ CD7- T cells and a monoclonal T-cell profile, demonstrated by T-cell receptor gene arrangement analysis, favour a diagnosis of PPD-like MF. Although the exact relationship between PPD and PPD-like MF remains unclear, our study has attached importance to the differential diagnosis of the two diseases in cases of overlooked MF variants. If persistent or generalized purpuric lesions are present, PPD-like MF should be taken into consideration. A thorough physical examination combined with pathological findings may lead to a correct diagnosis.
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Affiliation(s)
- Jingru Sun
- Department of Dermatology and Venerology, Peking University First Hospital, Beijing 100034, China, NMPA Key Laboratory for Quality Control and Evaluation of Cosmetics
| | - Kecen Liu
- Department of Dermatology and Venerology, Peking University First Hospital, Beijing 100034, China, NMPA Key Laboratory for Quality Control and Evaluation of Cosmetics
| | - Jingyang Dang
- Department of Dermatology and Venerology, Peking University First Hospital, Beijing 100034, China, NMPA Key Laboratory for Quality Control and Evaluation of Cosmetics
| | - Shan Xiong
- Department of Dermatology and Venerology, Peking University First Hospital, Beijing 100034, China, NMPA Key Laboratory for Quality Control and Evaluation of Cosmetics
| | - Haihao Pan
- Department of Dermatology and Venerology, Peking University First Hospital, Beijing 100034, China, NMPA Key Laboratory for Quality Control and Evaluation of Cosmetics
| | - Yang Wang
- Department of Dermatology and Venerology, Peking University First Hospital, Beijing 100034, China, NMPA Key Laboratory for Quality Control and Evaluation of Cosmetics
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15
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Galadari AA, Otaibi MA. Valsalva purpura on the face of a 7-year-old child. J Med Life 2023; 16:1869-1871. [PMID: 38585535 PMCID: PMC10994611 DOI: 10.25122/jml-2023-0447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 11/28/2023] [Indexed: 04/09/2024] Open
Abstract
Valsalva purpura refers to purpura resulting from performing the Valsalva maneuver, a forced expiratory effort against a closed glottis. There are limited reported cases of Valsalva purpura in children, specifically on the cheeks. We present the case of a 7-year-old child who developed Valsalva purpura on his cheeks after performing the Valsalva maneuver during deep breathing exercises by holding his breath underwater during his swimming sessions. This article overviews the relationship between the Valsalva maneuver, purpura, and similar cases.
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Affiliation(s)
| | - Moteb Al Otaibi
- Department of Medicine, Dermatology, Unaizah College of Medicine, Qassim University, KSA
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16
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González-García L, Fernández Martínez B, González Méndez C, Gonzalez-Garcia J. Limp, petechiae and gingival hypertrophy: Think of scurvy. An Pediatr (Barc) 2023; 99:219-220. [PMID: 37640661 DOI: 10.1016/j.anpede.2023.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 03/21/2023] [Accepted: 03/23/2023] [Indexed: 08/31/2023] Open
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17
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Gallo-Pineda G, Navarro-Navarro I. Perifollicular Purpura and Corkscrew Hairs. J Cutan Med Surg 2023; 27:544. [PMID: 37571826 DOI: 10.1177/12034754231194252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2023]
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18
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Agarwal A, Hamza Ansari M, Singh S. A female patient with purpuric lesions. Indian J Dermatol Venereol Leprol 2023; 89:757-759. [PMID: 37067121 DOI: 10.25259/ijdvl_784_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 04/05/2023] [Indexed: 03/31/2023]
Affiliation(s)
- Aanchal Agarwal
- Department of Dermatology & Venereology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Mohammad Hamza Ansari
- Department of Dermatology & Venereology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Sanjay Singh
- Department of Dermatology & Venereology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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19
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Ishizuka K, Ohira Y. Microscopic polyangiitis presenting with purpura and intermittent claudication. BMJ Case Rep 2023; 16:e256363. [PMID: 37558280 PMCID: PMC10414066 DOI: 10.1136/bcr-2023-256363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023] Open
Affiliation(s)
- Kosuke Ishizuka
- Department of General Medicine, Yokohama City University School of Medicine Graduate School of Medicine, Yokohama, Japan
| | - Yoshiyuki Ohira
- Department of General Internal Medicine, St Marianna University School of Medicine, Kawasaki, Japan
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20
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Vaishya R, Vaish A, Iyengar KP. Exercise-induced petechiae (EIP) of the forearm after intense, railing-assisted squat exercise. BMJ Case Rep 2023; 16:e255969. [PMID: 37451800 PMCID: PMC10351224 DOI: 10.1136/bcr-2023-255969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023] Open
Affiliation(s)
- Raju Vaishya
- Orthopaedic and Joint Replacement Surgery, Indraprastha Apollo Hospital, New Delhi, Delhi, India
| | - Abhishek Vaish
- Orthopaedic and Joint Replacement Surgery, Indraprastha Apollo Hospital, New Delhi, Delhi, India
- Orthopedics, Indraprastha Apollo Hospital, New Delhi, Delhi, India
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21
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Berna-Rico E, Melian-Olivera A. Cryoglobulinemic Vasculitis With Targetoid Purpura. J Cutan Med Surg 2023; 27:415. [PMID: 37073775 DOI: 10.1177/12034754231169265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Affiliation(s)
- Emilio Berna-Rico
- Dermatology Department, Ramon y Cajal University Hospital, IRYCIS, Madrid, Spain
| | - Ana Melian-Olivera
- Dermatology Department, Ramon y Cajal University Hospital, IRYCIS, Madrid, Spain
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Felser A, Agyeman P, Horn M, Stranzinger E, Kopp MV, Moser BS. A Forgotten Disease Presenting with Pseudoparalysis, Petechiae and Spontaneous Gingival Bleeding in a 3-Year-Old Toddler. Klin Padiatr 2023; 235:243-244. [PMID: 36848942 DOI: 10.1055/a-1970-6401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Affiliation(s)
- Andrea Felser
- Department of Paediatrics, Inselspital University Hospital Bern, Bern, Switzerland
| | - Philipp Agyeman
- Department of Paediatrics, Inselspital University Hospital Bern, Bern, Switzerland
| | - Matthias Horn
- Department of Paediatrics, Inselspital University Hospital Bern, Bern, Switzerland
| | - Enno Stranzinger
- Department of Diagnostic, Interventional and Paediatric Radiology, Inselspital University Hospital Bern, Bern, Switzerland
| | - Matthias V Kopp
- Department of Paediatrics, Inselspital University Hospital Bern, Bern, Switzerland
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23
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Shah R, Schwartz RA, Bhate C. Pigmenting Purpuric Dermatoses: Striking But Not a Manifestation of COVID-19 Infection. Cutis 2023; 112:E13-E16. [PMID: 37611310 DOI: 10.12788/cutis.0815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
Purpuric or erythematous eruptions of the lower extremities can be perplexing, especially because this clinical sign has been associated with COVID-19 infection. Since the start of the pandemic, COVID-19 often has been the first differential diagnosis for many clinical findings; however, pigmented purpuric dermatoses (PPDs) are distinctive, reassuring, eponymous, and not linked to this virus. In this article, we differentiate the PPDs and delineate them from potentially serious differential diagnoses, including inflammatory retiform purpura, leukocytoclastic vasculitis, stasis dermatitis, and cellulitis.
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Affiliation(s)
- Rohan Shah
- Department of Dermatology, Rutgers New Jersey Medical School, Newark. Drs. Schwartz and Bhate are from the Department of Pathology, Immunology, and Laboratory Medicine
| | - Robert A Schwartz
- Department of Dermatology, Rutgers New Jersey Medical School, Newark. Drs. Schwartz and Bhate are from the Department of Pathology, Immunology, and Laboratory Medicine
| | - Chinmoy Bhate
- Department of Dermatology, Rutgers New Jersey Medical School, Newark. Drs. Schwartz and Bhate are from the Department of Pathology, Immunology, and Laboratory Medicine
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24
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Affiliation(s)
- Daniel Shaw
- Royal Blackburn Hospital, East Lancashire Hospitals NHS Trust, Blackburn, Lancashire, UK
| | - Siddiq Fozdar
- Haslingden Healthcare, Haslingden, Rossendale, Lancashire, UK
| | - Caroline Owen
- Royal Blackburn Hospital, East Lancashire Hospitals NHS Trust, Blackburn, Lancashire, UK
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25
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Sitton B, Kaffenberger BH, Korman AM. Retiform Purpura on the Lower Legs. Cutis 2023; 111:E12-E14. [PMID: 37289690 DOI: 10.12788/cutis.0756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Beau Sitton
- Mr. Sitton is from The Ohio State University College of Medicine, Columbus. Drs. Kaffenberger and Korman are from the Department of Dermatology, The Ohio State University Wexner Medical Center
| | - Benjamin H Kaffenberger
- Mr. Sitton is from The Ohio State University College of Medicine, Columbus. Drs. Kaffenberger and Korman are from the Department of Dermatology, The Ohio State University Wexner Medical Center
| | - Abraham M Korman
- Mr. Sitton is from The Ohio State University College of Medicine, Columbus. Drs. Kaffenberger and Korman are from the Department of Dermatology, The Ohio State University Wexner Medical Center
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26
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Agud-Dios M, Rodríguez-Peralto JL, Velasco-Tamariz V. Nonpalpable Purpura in a Patient With Sjögren Syndrome. Actas Dermosifiliogr 2023; 114:161-162. [PMID: 35753360 DOI: 10.1016/j.ad.2021.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 05/26/2021] [Accepted: 06/06/2021] [Indexed: 02/06/2023] Open
Affiliation(s)
- M Agud-Dios
- Departamento de Dermatología, Hospital Universitario 12 de Octubre, Madrid, España.
| | - J L Rodríguez-Peralto
- Departamento de Anatomía Patológica, Hospital Universitario 12 de Octubre, Madrid, España
| | - V Velasco-Tamariz
- Departamento de Dermatología, Hospital Universitario 12 de Octubre, Madrid, España
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27
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Tamura N, Obara T, Yamada T, Nojima T, Nakamura S, Koide Y, Takaoka M, Naito H, Nakao A. Adult Scurvy Presenting with Painful Purpura on the Legs. Intern Med 2022; 61:1913-1916. [PMID: 34776490 PMCID: PMC9259809 DOI: 10.2169/internalmedicine.8409-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Prolonged vitamin C deficiency can result in numerous metabolic abnormalities like impaired tissue repair and defective collagen synthesis. This case report describes a middle-age Japanese man presenting painful purpura on his lower limbs, severe anemia, and altered consciousness. The patient had been eating a selective diet lacking in vegetables and fruits since childhood. A serum analysis demonstrated a low level of vitamin C. The patient was treated with vitamin supplementation and psychological intervention. Scurvy is an under-considered illness with a favorable prognosis if diagnosed early while it is still sporadically encountered in some patients with malabsorption or malnutrition even in modern times.
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Affiliation(s)
- Nayu Tamura
- Center for Graduate Medical Education, Okayama University Hospital, Japan
| | - Takafumi Obara
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan
| | - Taihei Yamada
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan
| | - Tsuyoshi Nojima
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan
| | - Shunsuke Nakamura
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan
| | - Yasuhiro Koide
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan
| | - Makoto Takaoka
- Department of Emergency, Steel Memorial Hirohata Hospital, Japan
| | - Hiromichi Naito
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan
| | - Atsunori Nakao
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan
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28
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Prukngampun N, Chartapisak W, Hongsawong N, Suwansirikul S, Sontichai W. A boy with purpura and generalized edema: Questions. Pediatr Nephrol 2022; 37:1319-1320. [PMID: 35084565 DOI: 10.1007/s00467-021-05385-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 11/24/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Natthida Prukngampun
- Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Wattana Chartapisak
- Division of Nephrology, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Nattaphorn Hongsawong
- Division of Nephrology, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Songkiet Suwansirikul
- Department of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Watchareewan Sontichai
- Division of Rheumatology, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
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29
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Tammaro A, Alexander S, Adebanjo GAR, Parisella FR, Rello J, Ramirez-Estrada S. Coexisting Purpuric and Pseudo-Chilblain Lesions in COVID-19 Patients. Skinmed 2022; 20:155-158. [PMID: 35532774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Antonella Tammaro
- Dermatology Department, NESMOS, Sapienza University of Rome, Rome, Italy;
| | - Shehani Alexander
- Dermatology Department, NESMOS, Sapienza University of Rome, Rome, Italy
| | | | | | - Jordi Rello
- Critical Care Department, Clínica Corachan, Barcelona, Spain
- Centro de Investigación Biomedica en Red de Enfermedades Respirorias (CIBERES), Instituto Salud Carlos III, Madrid, Spain
- Clinical Research/Epidemiology in Pneumonia and Sepsis (CRIPS), Vall d'Hebron Institut of Research (VHIR), Barcelona, Spain
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30
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Orita A, Miyauchi T, Ujiie I, Ujiie H. Characteristic Linear and Zigzag Purpuric Lesions in a Patient with Long-term and Repeated Exposure to Bedbug Bites. Acta Derm Venereol 2022; 102:adv00661. [PMID: 35199182 PMCID: PMC9631258 DOI: 10.2340/actadv.v102.753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
| | - Toshinari Miyauchi
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N15W7, Kita-Ku, Sapporo, 060-8638, Japan.
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31
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Al Khalili A, Billick R. Linear Pigmented Purpuric Dermatoses. Sultan Qaboos Univ Med J 2022; 22:593-594. [PMID: 36407701 PMCID: PMC9645523 DOI: 10.18295/squmj.1.2022.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 12/15/2021] [Accepted: 01/06/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- Ayida Al Khalili
- Department of Family Medicine and Public Health, Sultan Qaboos University Hospital, Muscat, Oman
| | - Robin Billick
- Department of Dermatology, Jewish General Hospital, McGill University, Montreal, Canada
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32
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Etti M, Sandhu G. Lower limb ecchymosis in a man with a history of alcohol misuse. BMJ 2021; 375:n2511. [PMID: 34737204 DOI: 10.1136/bmj.n2511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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33
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Warden D. Hyperpigmented lesion on left palm. J Fam Pract 2021; 70:459-460. [PMID: 34818155 DOI: 10.12788/jfp.0302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The location of the lesion and an insight into the patient's regular activities revealed the clinical diagnosis.
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34
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Affiliation(s)
- Hanno Hock
- From the Departments of Medicine (H.H., M.J.F.), Radiology (H.R.K.), and Pathology (L.R.M.), Massachusetts General Hospital, the Departments of Medicine (H.H., M.J.F.), Radiology (H.R.K.), and Pathology (L.R.M.), Harvard Medical School, and the Department of Radiology, Massachusetts Eye and Ear (H.R.K.) - all in Boston; and the Department of Medicine, Montefiore Medical Center, New York (E.A.M.)
| | - Hillary R Kelly
- From the Departments of Medicine (H.H., M.J.F.), Radiology (H.R.K.), and Pathology (L.R.M.), Massachusetts General Hospital, the Departments of Medicine (H.H., M.J.F.), Radiology (H.R.K.), and Pathology (L.R.M.), Harvard Medical School, and the Department of Radiology, Massachusetts Eye and Ear (H.R.K.) - all in Boston; and the Department of Medicine, Montefiore Medical Center, New York (E.A.M.)
| | - Eric A Meyerowitz
- From the Departments of Medicine (H.H., M.J.F.), Radiology (H.R.K.), and Pathology (L.R.M.), Massachusetts General Hospital, the Departments of Medicine (H.H., M.J.F.), Radiology (H.R.K.), and Pathology (L.R.M.), Harvard Medical School, and the Department of Radiology, Massachusetts Eye and Ear (H.R.K.) - all in Boston; and the Department of Medicine, Montefiore Medical Center, New York (E.A.M.)
| | - Matthew J Frigault
- From the Departments of Medicine (H.H., M.J.F.), Radiology (H.R.K.), and Pathology (L.R.M.), Massachusetts General Hospital, the Departments of Medicine (H.H., M.J.F.), Radiology (H.R.K.), and Pathology (L.R.M.), Harvard Medical School, and the Department of Radiology, Massachusetts Eye and Ear (H.R.K.) - all in Boston; and the Department of Medicine, Montefiore Medical Center, New York (E.A.M.)
| | - Lucas R Massoth
- From the Departments of Medicine (H.H., M.J.F.), Radiology (H.R.K.), and Pathology (L.R.M.), Massachusetts General Hospital, the Departments of Medicine (H.H., M.J.F.), Radiology (H.R.K.), and Pathology (L.R.M.), Harvard Medical School, and the Department of Radiology, Massachusetts Eye and Ear (H.R.K.) - all in Boston; and the Department of Medicine, Montefiore Medical Center, New York (E.A.M.)
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35
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Affiliation(s)
- Hiroaki Nakagawa
- Division of General Medicine, Aichi Medical University, Nagakute,
Japan
| | - Yasushi Miyata
- Department of Primary Care and Community Health, Aichi Medical University, Nagakute,
Japan
| | - Masato Maekawa
- Division of General Medicine, Aichi Medical University, Nagakute,
Japan
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36
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Ganzel C, Ben-Chetrit E. Immune Thrombocytopenia Following the Pfizer-BioNTech BNT162b2 mRNA COVID-19 Vaccine. Isr Med Assoc J 2021; 23:341. [PMID: 34155844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Chezi Ganzel
- Department of Hematology, Shaare Zedek Medical Center, Jerusalem, Israel
- Hadassah-Hebrew University Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Eli Ben-Chetrit
- Department of Infectious Diseases, Shaare Zedek Medical Center, Jerusalem, Israel
- Hadassah-Hebrew University Faculty of Medicine, Hebrew University of Jerusalem, Israel
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37
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Affiliation(s)
- Kevin D He
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Ken He
- Section of Hospital Medicine, VA Puget Sound Health Care System, Seattle, Washington
- Department of Medicine, University of Washington School of Medicine, Seattle
| | - Paul B Cornia
- Section of Hospital Medicine, VA Puget Sound Health Care System, Seattle, Washington
- Department of Medicine, University of Washington School of Medicine, Seattle
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38
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Affiliation(s)
- Ryohei Ono
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
- Department of Cardiology, Matsudo City General Hospital, Matsudo, Chiba, Japan
| | - Hidehisa Takahashi
- Department of Cardiology, Matsudo City General Hospital, Matsudo, Chiba, Japan
| | - Kenichi Fukushima
- Department of Cardiology, Matsudo City General Hospital, Matsudo, Chiba, Japan
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39
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Relvas M, Calvão J, Oliveira R, Cardoso JC, Gonçalo M. [Cutaneous Manifestations Associated with COVID-19: A Narrative Review]. ACTA MEDICA PORT 2021; 34:128-136. [PMID: 33315008 DOI: 10.20344/amp.14574] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 11/25/2020] [Accepted: 11/26/2020] [Indexed: 11/20/2022]
Abstract
INTRODUCTION COVID-19 is an infectious disease caused by the new coronavirus, SARS-CoV-2, that has spread rapidly throughout the world. This has resulted in an urgent need to obtain information regarding its pathogenesis, diagnosis and clinical manifestations. More specifically, skin manifestations, seldom reported initially, have been increasingly described. MATERIAL AND METHODS We performed a literature search in the PubMed database, regarding cutaneous manifestations associated with COVID-19. This article describes the clinical and histological findings of the main skin lesions observed in the context of SARS-CoV-2 infection. DISCUSSION Cutaneous manifestations associated with COVID-19 have been described in multiple retrospective and prospective studies, case series and case reports. The reported incidence reached 20.4%. Although there was substantial heterogeneity in terms of clinical patterns, the main ones include: erythematous/maculopapular, urticarial, papulovesicular, and purpuric/petechial eruptions, chilblain-like lesions and livedoid/acro-ischemic lesions. In the vast majority, the underlying pathophysiologic mechanisms are not fully understood, although histopathological findings and biomolecular studies can add relevant data. CONCLUSION The recognition of cutaneous manifestations associated with COVID-19 is of utmost importance. They may help establishing an early diagnosis, namely in oligosymptomatic patients or when confirmatory tests are impossible to perform. Moreover, chilblain-like lesions and acro-ischemia, also seem to play an important role in terms of prognosis.
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Affiliation(s)
- Maria Relvas
- Serviço de Dermatologia e Venereologia. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal
| | - Joana Calvão
- Serviço de Dermatologia e Venereologia. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal
| | - Raquel Oliveira
- Serviço de Medicina Interna. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal
| | - José Carlos Cardoso
- Serviço de Dermatologia e Venereologia. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal
| | - Margarida Gonçalo
- Serviço de Dermatologia e Venereologia. Centro Hospitalar e Universitário de Coimbra. Coimbra. Departamento de Dermatologia. Faculdade de Medicina. Universidade de Coimbra. Coimbra. Portugal
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40
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Davison G, Given A, Loughran C, Marjanovic J, Dalzell E. Perioral petechiae and pulmonary haemorrhage, thinking outside the vacuum. BMJ Case Rep 2021; 14:e240282. [PMID: 33472810 PMCID: PMC10577782 DOI: 10.1136/bcr-2020-240282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2020] [Indexed: 11/15/2022] Open
Affiliation(s)
- Gail Davison
- Centre for Medical Education, Queen's University Belfast Faculty of Medicine Health and Life Sciences, Belfast, UK
- Children's Emergency Department, Royal Belfast Hospital for Sick Children, Belfast, UK
| | - Andrew Given
- General Paediatrics, Royal Belfast Hospital for Sick Children, Belfast, UK
| | - Clare Loughran
- General Paediatrics, Royal Belfast Hospital for Sick Children, Belfast, UK
| | - Josip Marjanovic
- Radiology Department, Royal Belfast Hospital for Sick Children, Belfast, UK
| | - Elizabeth Dalzell
- Children's Emergency Department, Royal Belfast Hospital for Sick Children, Belfast, UK
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41
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Affiliation(s)
- Philippe Armand
- From the Department of Medicine, Brigham and Women's Hospital (P.A., S.K.), the Departments of Radiology (A.P.H.), Medicine (S.K.), and Pathology (M.K.-W.), Massachusetts General Hospital, the Departments of Radiology (A.P.H.), Population Medicine (S.K.), and Pathology (M.K.-W.), Harvard Medical School, and the Department of Population Medicine, Harvard Pilgrim Health Care Institute (S.K.) - all in Boston
| | - Allen P Heeger
- From the Department of Medicine, Brigham and Women's Hospital (P.A., S.K.), the Departments of Radiology (A.P.H.), Medicine (S.K.), and Pathology (M.K.-W.), Massachusetts General Hospital, the Departments of Radiology (A.P.H.), Population Medicine (S.K.), and Pathology (M.K.-W.), Harvard Medical School, and the Department of Population Medicine, Harvard Pilgrim Health Care Institute (S.K.) - all in Boston
| | - Sanjat Kanjilal
- From the Department of Medicine, Brigham and Women's Hospital (P.A., S.K.), the Departments of Radiology (A.P.H.), Medicine (S.K.), and Pathology (M.K.-W.), Massachusetts General Hospital, the Departments of Radiology (A.P.H.), Population Medicine (S.K.), and Pathology (M.K.-W.), Harvard Medical School, and the Department of Population Medicine, Harvard Pilgrim Health Care Institute (S.K.) - all in Boston
| | - Melissa Krystel-Whittemore
- From the Department of Medicine, Brigham and Women's Hospital (P.A., S.K.), the Departments of Radiology (A.P.H.), Medicine (S.K.), and Pathology (M.K.-W.), Massachusetts General Hospital, the Departments of Radiology (A.P.H.), Population Medicine (S.K.), and Pathology (M.K.-W.), Harvard Medical School, and the Department of Population Medicine, Harvard Pilgrim Health Care Institute (S.K.) - all in Boston
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42
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Monie DD, Meyer FB. Ependymal Petechial Hemorrhages in Bacterial Meningitis. Mayo Clin Proc 2020; 95:1940-1941. [PMID: 32861336 PMCID: PMC8556137 DOI: 10.1016/j.mayocp.2020.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 07/14/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Dileep D Monie
- Department of Neurosurgery, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Fredric B Meyer
- Department of Neurosurgery, Mayo Clinic College of Medicine and Science, Rochester, MN.
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43
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Magro C, Mulvey JJ, Berlin D, Nuovo G, Salvatore S, Harp J, Baxter-Stoltzfus A, Laurence J. Complement associated microvascular injury and thrombosis in the pathogenesis of severe COVID-19 infection: A report of five cases. Transl Res 2020. [PMID: 32299776 DOI: 10.1016/j.transl.2010.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Acute respiratory failure and a systemic coagulopathy are critical aspects of the morbidity and mortality characterizing infection with severe acute respiratory distress syndrome-associated coronavirus-2, the etiologic agent of Coronavirus disease 2019 (COVID-19). We examined skin and lung tissues from 5 patients with severe COVID-19 characterized by respiratory failure (n= 5) and purpuric skin rash (n = 3). COVID-19 pneumonitis was predominantly a pauci-inflammatory septal capillary injury with significant septal capillary mural and luminal fibrin deposition and permeation of the interalveolar septa by neutrophils. No viral cytopathic changes were observed and the diffuse alveolar damage (DAD) with hyaline membranes, inflammation, and type II pneumocyte hyperplasia, hallmarks of classic acute respiratory distress syndrome, were not prominent. These pulmonary findings were accompanied by significant deposits of terminal complement components C5b-9 (membrane attack complex), C4d, and mannose binding lectin (MBL)-associated serine protease (MASP)2, in the microvasculature, consistent with sustained, systemic activation of the complement pathways. The purpuric skin lesions similarly showed a pauci-inflammatory thrombogenic vasculopathy, with deposition of C5b-9 and C4d in both grossly involved and normally-appearing skin. In addition, there was co-localization of COVID-19 spike glycoproteins with C4d and C5b-9 in the interalveolar septa and the cutaneous microvasculature of 2 cases examined. In conclusion, at least a subset of sustained, severe COVID-19 may define a type of catastrophic microvascular injury syndrome mediated by activation of complement pathways and an associated procoagulant state. It provides a foundation for further exploration of the pathophysiologic importance of complement in COVID-19, and could suggest targets for specific intervention.
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Affiliation(s)
- Cynthia Magro
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | - J Justin Mulvey
- Department of Laboratory Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - David Berlin
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Weill Cornell Medicine, New York, New York
| | - Gerard Nuovo
- The Ohio State University Comprehensive Cancer Center, Columbus Ohio and Discovery Life Sciences, Powell, Ohio
| | - Steven Salvatore
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | - Joanna Harp
- Department of Dermatology, Weill Cornell Medicine
| | | | - Jeffrey Laurence
- Department of Medicine, Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, New York.
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44
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Magro C, Mulvey JJ, Berlin D, Nuovo G, Salvatore S, Harp J, Baxter-Stoltzfus A, Laurence J. Complement associated microvascular injury and thrombosis in the pathogenesis of severe COVID-19 infection: A report of five cases. Transl Res 2020; 220:1-13. [PMID: 32299776 PMCID: PMC7158248 DOI: 10.1016/j.trsl.2020.04.007] [Citation(s) in RCA: 1543] [Impact Index Per Article: 385.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 04/09/2020] [Indexed: 02/06/2023]
Abstract
Acute respiratory failure and a systemic coagulopathy are critical aspects of the morbidity and mortality characterizing infection with severe acute respiratory distress syndrome-associated coronavirus-2, the etiologic agent of Coronavirus disease 2019 (COVID-19). We examined skin and lung tissues from 5 patients with severe COVID-19 characterized by respiratory failure (n= 5) and purpuric skin rash (n = 3). COVID-19 pneumonitis was predominantly a pauci-inflammatory septal capillary injury with significant septal capillary mural and luminal fibrin deposition and permeation of the interalveolar septa by neutrophils. No viral cytopathic changes were observed and the diffuse alveolar damage (DAD) with hyaline membranes, inflammation, and type II pneumocyte hyperplasia, hallmarks of classic acute respiratory distress syndrome, were not prominent. These pulmonary findings were accompanied by significant deposits of terminal complement components C5b-9 (membrane attack complex), C4d, and mannose binding lectin (MBL)-associated serine protease (MASP)2, in the microvasculature, consistent with sustained, systemic activation of the complement pathways. The purpuric skin lesions similarly showed a pauci-inflammatory thrombogenic vasculopathy, with deposition of C5b-9 and C4d in both grossly involved and normally-appearing skin. In addition, there was co-localization of COVID-19 spike glycoproteins with C4d and C5b-9 in the interalveolar septa and the cutaneous microvasculature of 2 cases examined. In conclusion, at least a subset of sustained, severe COVID-19 may define a type of catastrophic microvascular injury syndrome mediated by activation of complement pathways and an associated procoagulant state. It provides a foundation for further exploration of the pathophysiologic importance of complement in COVID-19, and could suggest targets for specific intervention.
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Affiliation(s)
- Cynthia Magro
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | - J Justin Mulvey
- Department of Laboratory Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - David Berlin
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Weill Cornell Medicine, New York, New York
| | - Gerard Nuovo
- The Ohio State University Comprehensive Cancer Center, Columbus Ohio and Discovery Life Sciences, Powell, Ohio
| | - Steven Salvatore
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | - Joanna Harp
- Department of Dermatology, Weill Cornell Medicine
| | | | - Jeffrey Laurence
- Department of Medicine, Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, New York.
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45
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Sweet JM, Mulkey BH. Lower Extremity Petechiae and Purpura. Am Fam Physician 2020; 101:567-568. [PMID: 32352732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
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46
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St Clair B, Addis KM, Rush JL. Petechiae and ecchymoses on the arm. Cutis 2020; 105:E2-E3. [PMID: 32603394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Blake St Clair
- Department of Dermatology, University of Arkansas for Medical Sciences, Little Rock, USA
| | | | - J Logan Rush
- Department of Dermatology, University of Arkansas for Medical Sciences, Little Rock, USA
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47
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Liebman TN, Tamez R, Daly JA. Calciphylaxis in Association with Alcoholic Cirrhosis and Hepatorenal Syndrome. Skinmed 2020; 18:46-49. [PMID: 32167457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
A 45-year-old woman with cirrhosis secondary to alcohol abuse was transferred from an outside hospital for management of a painful cutaneous eruption, progressively worsening over 2 weeks. On examination, the patient was a middle-aged white woman lying in bed in no acute distress, with jaundice and a protuberant abdomen consistent with ascites. The patient was afebrile (98.2°F), heart rate of 79 beats per minute, blood pressure of 105/61 mmHg, respiratory rate of 18 breaths per minute, and oxygen saturation of 93% on room air. She had multiple large stellate lesions of retiform purpura with central hemorrhagic necrosis on both thighs, with surrounding induration (Figures 1 and 2). These purpuric plaques and perilesional skin were exquisitely painful to palpation.
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Affiliation(s)
- Tracey N Liebman
- Ronald O. Perelman Department of Dermatology, NYU School of Medicine; New York, NY
| | - Rebecca Tamez
- Department of Dermatology, Hofstra Northwell School of Medicine, Manhasset, NY
| | - Jeanine A Daly
- Department of Dermatology, Hofstra Northwell School of Medicine, Manhasset, NY;
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48
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van Baalen E, Trajkovic M, Boiten HJ. A Patient With Psychiatric Illness and Multiple Hemorrhages. JAMA 2019; 322:2437-2438. [PMID: 31808783 DOI: 10.1001/jama.2019.17173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Eske van Baalen
- Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | - Marija Trajkovic
- Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | - Henk-Jan Boiten
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
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Bramson R, Trinh A. 8-year-old boy • palpable purpura on the legs with arthralgia • absence of coagulopathy • upper respiratory infection • Dx? J Fam Pract 2019; 68:411-414. [PMID: 31532816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
| | - Andrew Trinh
- Texas A&M College of Medicine, Baylor University Medical Center, Dallas, USA
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Szterenlicht YM, Jarjoui A, Kurd R, Levy L, Munter G. A Peculiar Case of Purpura. Am J Med 2019; 132:934-935. [PMID: 30904505 DOI: 10.1016/j.amjmed.2019.02.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 02/27/2019] [Accepted: 02/28/2019] [Indexed: 11/18/2022]
Affiliation(s)
- Yael M Szterenlicht
- Department of Internal Medicine C, Shaare Zedek Medical Center, affiliated with the Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Amir Jarjoui
- Department of Internal Medicine C, Shaare Zedek Medical Center, affiliated with the Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Ramzi Kurd
- Department of Internal Medicine C, Shaare Zedek Medical Center, affiliated with the Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Ludmila Levy
- Department of Internal Medicine C, Shaare Zedek Medical Center, affiliated with the Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Gabriel Munter
- Department of Internal Medicine C, Shaare Zedek Medical Center, affiliated with the Hebrew University-Hadassah Medical School, Jerusalem, Israel.
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