Endgames Spot Diagnosis

A rash localised around the eyes

BMJ 2017; 358 doi: https://doi.org/10.1136/bmj.j3148 (Published 13 July 2017) Cite this as: BMJ 2017;358:j3148
  1. Mitsuhito Ota, dermatologist and, director
  1. Department of Dermatology, Chitose City Hospital Hokkou 2, Chitose, Japan
  1. Correspondence to ota{at}med.hokudai.ac.jp

A 26 year old woman presented with a sudden rash on the face (fig 1). The previous day, she had had severe vomiting, diarrhoea, and fever, and had been diagnosed with acute viral gastroenteritis. The rash was localised around the eyes. What is the cause of rash?

Fig 1 Localised peri-orbital pinpoint rash

Answer

The diagnosis is facial purpura caused by emesis. The cause is rupture of capillaries in the upper dermis resulting from elevated intravascular pressure during vomiting.

Discussion

Purpura is caused by extravasation of …

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