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palpable purpura
Palpable lesions with purpura. (Also see purpura)
Etiology:
1) small-vessel vasculitis
a) leukocytoclastic vasculitis* - Henoch-Schonlein purpura
b) eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome)
b) polyarteritis nodosa
c) systemic lupus erythematosus
d) mixed cryoglobulinemia
2) emboli
a) acute meningiococcemia
b) disseminated gonococcal infection
c) rickettsial
1] Rocky Mountain spotted fever
2] epidemic typhus
d) ecthyma gangrenosum
3) infectious (also see emboli)
a) hepatitis, hepatitis C [2]
b) atypical measles
c) echovirus 9
d) TORCH group
e) Staphylococcus
f) Pseudomonas sepsis
g) bacterial endocarditis
h) HIV
* a hypersensitivity vasculitis
Laboratory:
- skin biopsy
Complications:
- small vessel vasculitis may affect internal organs [2]
Differential diagnosis:
- erythema nodosum (tender or painful)
- see small-vessel vasculitis for differential diagnosis
Management:
- cutaneous small vessel vasculitis (palpable purpura) can be managed with
- rest & elevation of affected region
- topical glucocorticoids
- NSAIDs
- antihistamines [1]
Related
erythema nodosum (septal panniculitis)
General
sign/symptom
purpura; retiform purpura
References
- Stedman's Medical Dictionary 27th ed, Williams &
Wilkins, Baltimore, 1999
- Medical Knowledge Self Assessment Program (MKSAP) 14, 17, 18.
American College of Physicians, Philadelphia 2006, 2015, 2018.
- NEJM Knowledge+ Allergy/Immunology