Rash diagnosis of blood expectoration

Abstract

In June, 2010, a previously healthy 29-year-old man presented with bloody sputum (200 mL). He had an 8-day history of cough, throat pain, and fever and was referred to our intensive care unit for bronchial arteriography. Amoxicillin-clavulanate therapy had been started 2 days before admission and a slight maculopapular eruption began the day before. Physical examination showed a temperature of 37·8°C, conjunctivitis, pharyngitis, and skin eruption. Laboratory test results were normal, except for lymphopenia. We thought that our patient was expectorating blood from the upper airways rather than coughing it up because of positive throat scraping. Bleeding from the respiratory or digestive tract was excluded by Multidetector CTAngiography, (Sensation 16, Siemens Healthcare, Erlangen, Germany) which showed mild mediastinal and bilateral hilar lymphad enopathy associated with thickening of the bronchial walls without parenchymal signs of haemop tysis or bronchial artery enlargement. Fibre-optic bronchoscopy and oesophagogastroduodenal endoscopy showed no abnormalities. A month earlier, during a measles outbreak in our region a similar case of a young patient expectorating blood during intense throat scraping, and a rash appearing the day after, had been diagnosed as measles eventually. Measles was also confi rmed in our patient by reverse transcription PCR of a nasopharyngeal sample. He was placed under respira tory isolation and discharged after 5 days; at the 1-year check-up in June, 2011, he had fully recovered without any recurrence of bleeding. Currently, measles is increasing in several European countries, and early diagnosis is essential to control any new outbreak. Measles is usually characterised by a prodrome phase including fever, cough, coryza, conjunctivitis, and Koplik’s spots, followed by a confl uent rash; more rarely life-threatening complications such as