Purpura

Background

Palpable petechiae and purpura are a result of either perivascular inflammation (vasculitis) or infection.
Non-palpable petechiae usually occur in low platelet states such as ITP and DIC

Rash Red Flags[1]

Fever
Toxic appearance
Hypotension
Mucosal lesions
Severe pain
Very old or young age
Immunosuppressed
New medication

Clinical Features

Palpable Purpura

Petechiae

Both petechia and purpura do not blanch

Purpura subdivided into:
- <2mm of hemorrhage: petechiae
- >2mm of hemorrhage: ecchymoses

Purpural Rash

Differential Diagnosis

Petechiae/Purpura (by cause)

Abnormal platelet count and/or coagulation
- Septicemia
- Idiopathic thrombocytopenic purpura (ITP)
- Hemolytic uremic syndrome
- Leukemia
- Coagulopathies (e.g. hemophilia)
- Henoch-Schonlein Purpura (HSP)
- Acute hemorrhagic edema of infancy (AHEI)
Hypersensitivity vasculitis
Primary vasculitides
- Wegener's
- Microscopic polyangiitis
- Eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome)
Secondary vasculitides
- Henoch-Schonlein purpura
- Connective tissue disorder
  - Systemic lupus erythematosus
- Scurvy
- Infectious disease
  - Hepatitis B
  - Hepatitis C
Trauma

Petechiae/Purpura (by findings)

Febrile, toxic
- Palpable
  - Meningococcemia
  - Disseminated gonococcal infection
  - Endocarditis
  - Rocky mountain spotted fever
  - HSP
- Non-palpable
  - Purpura fulminans
  - DIC
  - TTP
Afebrile, nontoxic
- Palpable
  - Autoimmune vasculitis
- Non-palpable
  - ITP

Evaluation

Rash visual diagnosis

Henoch-schonlein purpura
Splinter hemorrhage (endocarditis)

Management

Management directed by underlying condition

Disposition

See Also

Rashes

References

Nguyen T and Freedman J. Dermatologic Emergencies: Diagnosing and Managing Life-Threatening Rashes. Emergency Medicine Practice. September 2002 volume 4 no 9.

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