Purpura
| Purpura | |
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| ICD-10 | D69 |
| ICD-9 | 287 |
| DiseasesDB | 25619 |
| MeSH | D011693 |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Purpura (from the Latin, purpura, meaning "purple") is the appearance of red or purple discolorations on the skin, caused by bleeding underneath the skin. Small spots are called petechiae, while large spots are called ecchymoses.
This is common with typhus and can be present with meningitis caused by meningococcal meningitis or septicaemia.
Classification
Purpura is a common and unspecific symptom, however the underlying mechanism commonly involves one of the following:
- Platelet disorders
- Primary thrombocytopenic purpura
- Secondary thrombocytopenic purpura
- Vascular disorders
- Microvascular injury, as seen in senile (old age) purpura, when blood vessels are more easily damaged
- Hypertensive states
- Deficient vascular support
- Vasculitis, as in the case of Henoch-Schönlein purpura
- Coagulation disorders
There are also cases of psychogenic purpura described in the medical literature,[1] some claimed to be due to "autoerythrocyte sensitization". Other studies[2] suggest, that local (cutaneous) activity of tPA can be increased in psychogenic purpura, leading to substantial amounts of localized plasmin activity, rapid degradation of fibrin clots, and resultant bleeding.
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Petechial spots over the back
Differential Diagnosis of Causes of Purpura in alphabetical order
In alphabetical order. [3] [4]
- Allopurinol
- Atropine
- "Blueberry muffin baby"
- Child abuse
- Chloral hydrate
- Chronic stasis
- Churg - Strauss syndrome
- Cimetidine
- Corticosteroids
- Coxsackie Virus
- Disseminated Intravascular Coagulation
- Echo Virus
- Ehlers-Danlos syndrome
- Factitious purpura
- Factor VIII deficiency
- Factor IX deficiency
- Gardner-Diamond Syndrome
- Gold
- Hemolytic Uremic Syndrome
- Henoch - Schonlein Purpura
- Hepatitis B
- Hereditary hemorrhagic telangiectasia
- Hodgkin's Lymphoma
- Hydralazine
- Iodine
- Ketoconazole
- Leukocytoclastic vasculitis
- Liver Disease
- Lupus Erythematosus
- Measles
- Meningococcemia
- Myeloma
- Penicillin
- Phenytoin
- Platelet dysfunction
- Polyarteritis Nodosa
- Propylthiouracil
- Quinidine
- Religious rituals
- Rheumatoid Arthritis
- Rocky Mountain Spotted Fever
- Scurvy
- Scarlet Fever
- Sjogren's Syndrome
- Septic emboli
- Serum sickness
- Strangulation
- Subacute bacterial endocarditis
- Sulfonamides
- Tetracycline
- Thiazides
- Thrombocytopenia
- Typhoid
- Vitamin K deficiency
- Violent coughing
- Vomiting
- Von Willebrand's Disease
- Wegener's Granulomatosis
Diagnosis
History and Symptoms
- present illness
- medicinal history
- system review
- CNS symptoms
Laboratory Findings
- Labs include
- ANA
- Blood cultures
- BUN / Creatinine
- CBC with differential
- C-reactive protein
- ESR
- PT/PTT/INR
- urinalysis
- LFTs
- Rheumatoid factor
Treatment
Acute Pharmacotherapies
- Infections
- RMSF - doxycycline
- Meningococcemia - ceftriaxone
Chronic Pharmacotherapies
- Autoimmune disease
- methotrexate
- cyclosporine
- azathioprine
- mycopheolate mofetil
Primary Prevention
- Discontinue contributory medication
- Sun protection
- Avoid trauma
References
- ↑ Anderson JE, DeGoff W, McNamara M (1999). "Autoerythrocyte sensitization (psychogenic purpura): a case report and review of the literature". Pediatric emergency care. 15 (1): 47–8. PMID 10069314.
- ↑ Lotti T, Benci M, Sarti MG, Teofoli P, Senesi C, Bonan P; et al. (1993). "Psychogenic purpura with abnormallt cutaney increased tPA dependeny". 32 (7): 521–3. PMID 8340191. Unknown parameter
|journous fibrinolytic activital=ignored (help) - ↑ Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016
- ↑ Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X