Petechial rash on the extremities

doi:10.1136/bmj.b1284

Published 15 April 2009, doi:10.1136/bmj.b1284
Cite this as: BMJ 2009;338:b1284

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Petechial rash on the extremities

Stephanie St Pierre, medical student¹, Marisa Potter, dermatology resident², Scott P Prawer, dermatology resident (graduated), dermatologist²^,3, Pitiporn Suwattee, assistant professor of dermatology⁴

¹ University of Minnesota Medical School, Minneapolis, MN, 55455 USA , ² Department of Dermatology, University of Minnesota, Minneapolis, MN, 55455 USA , ³ Private Practice, Fridley, MN, 55432 USA , ⁴ Minneapolis Veterans Affairs Medical Center, Minneapolis, MN, 55417 USA

Correspondence to: P Suwattee suwat001@umn.edu

The first 150 words of the full text of this article appear below.

A 53 year old, afebrile woman presented to the dermatology clinicwith a two week history of petechial rash on her lower extremitiesthat had progressed up to her arms. In addition, she also hadpain in the wrists, knees, and elbows. Approximately five monthsearlier, she had been diagnosed with group A streptococcal pharyngealinfection, but she had not been treated with antibiotics. Shewas currently taking salbutamol, famciclovir, levothyroxine,lovastatin, and varenicline. A systems review was unremarkableand she had no reported haematuria, abdominal pain, or bloodystools.

A physical examination found multiple petechial macules, papules,and purpuric plaques, which were more numerous on the legs thanon the arms (figure[F1]). A complete blood count and coagulationstudies were normal. Urinalysis showed haematuria and proteinuria.A skin biopsy of a petechial papule revealed leucocytoclasticvasculitis, with a granular IgA reactivity around the bloodvessels in the papillary dermis.