Purpuric Plaques Research Articles

Acute hemorrhagic edema of infancy: 20-year experience from an Italian tertiary referral center.

Data on acute hemorrhagic edema of infancy (AHEI) are derived from small case series or case reports. We report a 20-year experience at a national referral center. We performed a single-center retrospective study including patients who were diagnosed with AHEI from January 1, 2004, to June 30, 2023. We identified 21 patients (57.1% females) with a median age of 18 months (range 7-33 months). Thirteen (61.9%) patients were admitted to the pediatric ward, the remaining eight (38.1%) presented to the emergency department and were discharged for outpatient management. The median length of hospitalization was 5 days (range 3-9 days). Twenty patients (95.2%) had prodromal symptoms. The most common cutaneous findings were targetoid purpuric plaques. The lesions were most localized on the face (13, 61.9%) and on the upper limbs (18 patients, 85.7%). Sixteen (76%) patients presented with nonpitting and tender edema, localized on the feet (9/16, 56%) and hands (6/16, 37.5%). Systemic involvement was rare, and no patients experienced complications or sequelae. Twelve (57.1%) patients underwent infectious disease investigations, with positive results in only four (33.3%). None of the patients diagnosed after the SARS-CoV-2 outbreak (March 2020) had positive nasopharyngeal swabs for the virus. For the 13 patients who were admitted to the pediatric ward, the median length of hospitalization was five days (3-9 days). The 21-patient single-center cohort of children affected by AHEI confirmed a generally benign course of AHEI, despite a 62% rate of hospitalization.

Young Woman With Annular and Purpuric Plaques in the Setting of High Fevers: Challenge

Young Woman With Annular and Purpuric Plaques in the Setting of High Fevers: Challenge

Young Woman With Annular and Purpuric Plaques in the Setting of High Fevers: Answer

Young Woman With Annular and Purpuric Plaques in the Setting of High Fevers: Answer

Recurrent cutaneous eosinophilic vasculitis characterized by annular purpuric lesions: A case report

A 71-year-old woman presented with a persistent, intensely pruritic cutaneous eruption localized on the palmoplantar regions, lips and palate. The histological findings allowed to make the diagnosis of recurrent cutaneous eosinophilic vasculitis, a very rare cutaneous vasculitis characterized clinically by multiple erythematous or purpuric erythematous papules or plaques or angioedema with a relapsing course in the absence of systemic involvement and histologically by a necrotizing vasculitis of the dermal small vessels with a dominant eosinophilic infiltration. The patient was treated with oral methylprednisolone and pentoxifylline which led to a rapid resolution of the cutaneous lesions.

Multiple Cutaneous Features Associated with Primary Sjogren’s Syndrome

Sjogren’s syndrome is a systemic autoimmune disorder that mainly affects exocrine glands, although the clinical manifestations include both exocrine gland involvement and extraglandular disease features. In addition to dryness, musculoskeletal pain and fatigue are the hallmarks of this disease and constitute the classic symptom triad presented by the vast majority of patients. The authors present the case of a 59-year-old woman with achalasia, sicca syndrome, subcutaneous nodules affecting the knees, purpuric plaques on the palms and vitiligo. Serological tests were consistent with Sjögren′s syndrome, therefore the diagnosis of primary Sjögren’s syndrome with extensive cutaneous manifestations as extraglandular organ involvement was made.

Pruritic postoperative eruption

A 50-year-old woman presented 11 days following total knee arthroplasty with a 2-day history of an intensely pruritic rash and a reported fever of 38.3 °C. Postoperative medications included hydrocodone/acetaminophen and celecoxib. Dermatologic examination revealed a purpuric plaque with an overlying bulla on the right ventral wrist and a targetoid plaque on the right palm. Pink, edematous papules and plaques, some targetoid in appearance, were present diffusely (Fig 1, A–C). The surgical incision site showed no signs of infection.

Covid 19 induced destructive impact on a leprosy patient

COVID-19 pandemic has caused marked economic, social, and health impacts. People affected by leprosy have additionally been hit via way of means by the pandemic. Many patients have missed their monthly medications. Here is a report of one such case who presented with vasculonecrotic erythema nodosum due to discontinuation of MB MDT therapy.A 26-year-old man affected with leprosy presented to our OPD with a 2- month history of fever, hemorrhagic blisters and ulcers over extremities. On examination, purpuric plaques, hemorrhagic bullae and necrotic ulcers were found on the face and extremities along with erythematous edematous lesions on the trunk. The diagnosis of vasculonecrotic erythema nodosum was made with the characteristic clinical and diagnostic features.Leprosy is a chronic disease with various atypical, rare and unrecognizable manifestations. Early diagnosis and prompt treatment are needed to reduce morbidity and mortality. In this Covid situation, special attention should be paid to chronic diseases such as leprosy by giving appropriate guidelines on how to treat them.

Polycyclic rash with persistent eosinophilia

A 56-year-old man with no past medical history presented with dry cough and dyspnea. He was given antibiotics and bronchodilators which did not improve his symptoms. Three years after the initial symptoms began, he developed persistent hypereosinophilia with an absolute eosinophil count as high as 2250 cells/uL. Prednisone (40 mg daily) was initially helpful, but his symptoms returned once the drug was tapered. Subsequently, he developed new myalgias, arthralgias, joint swelling, hives, and polycyclic purpuric plaques with hemorrhagic zones and erythema on his trunk and extremities (Figs 1 and 2).

Diffuse dermal angiomatosis of the breast: an emerging entity in the setting of cutaneous reactive angiomatoses

New and emerging types of cutaneous vascular (capillary) proliferations have been described or better categorized in the last few years. They include reactive angioendotheliomatosis, acroangiodermatitis (pseudo-Kaposi sarcoma), diffuse dermal angiomatosis, intravascular histiocytosis, glomeruloid angioendotheliomatosis, and angiopericytomatosis (angiomatosis with cryoproteins). Clinically, they are characterized by multiple, red violaceous, and purpuric patches and plaques, sometimes evolving toward necrosis and ulceration with a wide distribution but a propensity to involve the extremities. Histologically, they are characterized by different patterns of intravascular or extravascular lobular or diffuse hyperplasia of endothelial cells, pericytes, and sometimes histiocytes. Although these angioproliferations can histologically have a pseudoangiosarcomatous pattern, they are reactive in that they originate from the (sub)occlusion of vascular lumina by different localized or systemic disorders. The vascular proliferation stops after the inducing hypoxic stimulus has been withdrawn. Among them, diffuse dermal angiomatosis of the breast is a variant of diffuse dermal angiomatosis involving middle-aged women with macromastia, obesity, smoking, and vasculopathic disorders, considered a distinct disorder in the spectrum of cutaneous reactive angiomatoses. It presents with reticulated erythematous to purple patches with sometimes a tendency to ulcerate and bleeding, appearing on large, pendulous breasts. The pathogenesis is related to tissue hypoxemia resulting from subclinical torsion, compression, and increased venous hydrostatic pressure due to the macromastia, aggravated by the associated ischemic conditions such as hypertension and diabetes. There is no evidence-based therapy, but reduction mammoplasty is a viable treatment option. This should be evaluated in all patients who fail conservative therapy.

Purpuric plaques in a patient with breast cancer

A 55-year-old woman with a recent history of metastatic breast cancer to bone presented with a purpuric rash on her jaw, neck, and chest (Fig 1). A hypercoagulability evaluation revealed an elevated activated partial thromboplastin time as well as lupus anticoagulant and anticardiolipin antibodies. The patient had no symptoms indicating infection. A lesional skin biopsy was performed and revealed ectatic, although not atypical, vascular spaces in the dermis, some of which were filled with clusters of cells in direct contact with the vessel walls (Fig 2, A).

Chilblains in children in the time of COVID-19: New evidence with serology assay.

In a previous report in Pediatric Dermatology, we described chilblains-like lesions in four pediatric patients. From April 18 to May 10, 2020, 45 children presented to our Pediatric Dermatology department with similar acral lesions. The clinical appearance ranged from red to violaceous macules and dusky, purpuric plaques on the heels, soles and lateral margin of the feet, often accompanied by painful edema, consistent with chilblains.

Acute Hemorrhagic Edema of Infancy: A Diagnostic Challenge for the General Pediatrician.

Acute hemorrhagic edema of infancy (AHEI), a benign and self-limited disease, can be easily mistaken to be a number of diseases with similar dermatological manifestations but with potentially adverse outcomes. This review aimed to familiarize pediatricians with the natural history, clinical manifestations, diagnosis, and management of AHEI. A PubMed search was conducted in February 2020 in Clinical Queries using the key terms "acute hemorrhagic edema of infancy" OR "Finkelstein disease" OR "Seidlmayer disease". The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews published within the past 10 years. Only papers published in the English literature were included in this review. The information retrieved from the above search was used in the compilation of the present article. AHEI, a rare cutaneous leukocytoclastic small-vessel vasculitis, typically presents with palpable purpura, peripheral acral edema, and frequently with fever, most often in children between 4 and 24 months of age. A significant number of children experience prodromal symptoms of an upper respiratory infection. Fever is typically low grade and is present in approximately 50% of cases. The cutaneous lesions are characterized by rapid onset of small erythematous macules or papules that progress to well demarcated, annular, rosette, medallion-like, or targetoid purpuric plaques or ecchymosis in 24 to 48 hours. The skin lesions are typically palpable, nonpruritic, and symmetrically distributed. Sites of predilection include the face, auricles, and extremities. Edema is typically nonpitting and asymmetrical and occurs primarily on the dorsum of the hands and feet, the face, and the auricles. In spite of the acuteness and extent of the cutaneous findings, the child looks well and nontoxic. Systemic and/or visceral involvement are rare. The differential diagnosis is broad and includes, among others, Henoch-Schönlein purpura. It is crucial to distinguish AHEI from the other diseases since the management of these diseases is quite different. The clinical features of mimickers of AHEI are reviewed and clues to differentiate AHEI from these mimickers are highlighted..AHEI is a benign, self-limited disease with complete spontaneous recovery in one to three weeks in the majority of cases. Recognizing this rare disease is important for the pediatrician to rapidly differentiate AHEI from other potentially serious diseases that require prompt therapy and monitoring. With rapid recognition of AHEI, unnecessary investigations and inappropriate interventions can be prevented and parental anxiety can be avoided.

Clustered cases of acral perniosis: Clinical features, histopathology, and relationship to COVID-19.

Background/ObjectivesA recent marked increase in pediatric and adult patients presenting with purpuric acral lesions concerning for ischemia, thrombosis and necrosis has been observed in COVID‐19 prevalent regions worldwide. The clinical and histopathological features and relationship to COVID‐19 have not been well described. The objective of this case series is to describe the clinical features and determine the histopathologic findings and clinical implications of the clusters of acral perniosis cases identified in pediatric patients.MethodsWe describe six otherwise healthy adolescents—three siblings per family from two unrelated families—presented within a 48‐hour period in April, 2020, with acral perniosis‐like lesions in the context of over 30 similar patients who were evaluated within the same week.ResultsAffected patients had mild symptoms of viral upper respiratory infection (URI) or contact with symptomatic persons 1‐2 weeks preceding the rash. They all presented with red to violaceous macules and dusky, purpuric plaques scattered on the mid and distal aspects of the toes. Skin biopsies performed on each of the six patients demonstrated near identical histopathologic findings to those of idiopathic perniosis, with a lymphocytic inflammatory infiltrate without evidence of thromboembolism or immune complex vasculitis. While SARS‐CoV‐2 polymerase chain reaction was negative, testing was performed 1‐2 weeks after URI symptoms or sick contact exposure.ConclusionWe offer a clinical approach to evaluation of patients with this presentation and discuss the possibility that these skin findings represent a convalescent‐phase cutaneous reaction to SARS‐CoV‐2 infection.

Purpuric plaques with hemorrhagic bullae on both arms

Purpuric plaques with hemorrhagic bullae on both arms

Solitary purpuric plaque: clinical and dermoscopic evolution of lichen aureus

Solitary purpuric plaque: clinical and dermoscopic evolution of lichen aureus

A rare vasculitis with a dramatic presentation: Acute hemorrhagic edema of infancy

Acute hemorrhagic edema of infancy is a disease marked by its dramatic presentation of purpuric plaques in a cockade or targetoid pattern. A 1-year-old boy was brought by his mother to our outpatient department with large purpuric plaques in annular and cockade pattern over the cheeks and bilateral lower limbs. Both the pinna showed purpura in a peculiar reticulate pattern, with vesiculation seen at the margin of the lesions along with mild edema. The skin biopsy showed cutaneous small-vessel vasculitis; direct immunofluorescence showed fibrinogen deposits around the small cutaneous vessels. The unusual features of our case were the reticulate pattern of purpura seen over the ears.

Programmed cell death protein 1 inhibitor-induced recalcitrant mixed small and medium vessel vasculitis

Pembrolizumab, a programmed cell death protein 1 (PD1) inhibitor, has been known to be associated with several adverse reactions, including immune related adverse events. In less than one percent of patients, PD1 inhibitors have been linked to the development of connective tissue disease. Patients with previously known connective tissue disease are hypothesized to be at increased risk of flares in as many as 40% of cases. A 70-year-old man with a past medical history significant for rheumatoid arthritis in remission and stage IV lung adenocarcinoma presented to the dermatology clinic after one cycle of nivolumab and eight cycles of pembrolizumab exhibiting worsening, painful bilateral lower extremity ulcers for approximately one month. On the lower legs, three large black retiform eschars and bullous purpuric plaques were observed. Vasculitis is a rare complication of PD1 inhibitor therapy, with the majority of cases reported in literature either medium vessel or large vessel vasculitis. Only glucocorticoids have proven effective for PD1-induced vasculitis and these patients generally require multi-specialty management.

L’infection à Parvovirus B19, diagnostic différentiel de toxidermie dans le syndrome Babouin

IntroductionBaboon syndrome is a rare form of rash affecting the large skin folds. We report a case involving primary infection with parvovirus B19. Patients and methodsA 34-year-old female patient with no particular history consulted for a pruriginous rash on the large skin folds in a setting of fever present for 6 days. She was not taking any medication. Clinical examination showed large symmetrical erythematous purpuric plaques on flexion folds. No mucosal damage or systemic signs were seen. The laboratory tests showed inflammatory syndrome. A skin biopsy demonstrated leukocytoclastic vasculitis. The viral serology was positive for parvovirus B19 (immunoglobulins, IgM). The patient was treated with antihistamines and emollients, and the skin lesions regressed spontaneously after 10 days. DiscussionBaboon syndrome was formerly considered simply as a skin condition. It has now been attributed to several other aetiologies including viral infections. Our case was linked to a primary parvovirus B19 infection. This virus can cause polymorphic skin signs and constitutes a differential diagnosis for rash in Baboon syndrome.

Systemic lupus erythematosus presenting as toxic epidermal necrolysis

A 27-year-old woman presented with 6 weeks’ history of painful, raised purpuric lesions followed by blisters and sheet-like desquamation on the face, extremities and trunk involving approximately 30% of body...

Glans penis necrosis caused by calcific uremic arteriolopathy

Calcific uremic arteriolopathy (CUA) or calciphylaxis is a syndrome characterized by calcification of vessels located in the dermis and adipose tissue. It commonly occurs in patients with diabetes mellitus, hypertension, and end-stage renal disease. Clinical presentation generally begins with severe pain, followed by the presence of liveloid or purpuric plaques. Later the formation necrotic ulcers occur. This condition is associated with a poor prognosis, with a high rate of mortality within months of the diagnosis. Penile involvement is an uncommon but severe manifestation. We present an 81-year-old man with a history of diabetes mellitus, hypertension, and end-stage renal disease with a one-month evolution of painful necrotic ulcers on his glans penis. He was diagnosed with CUA. Owing to infection complicated by sepsis; penectomy was performed. Unfortunately, the patient died of myocardial infarction during his hospitalization.