Differentiating Deep Tissue Pressure Injury (DTPI) From Other Causes of Purpura in the Sacrococcygeal Area: A Multiple Case Series.

BACKGROUND: Recent revisions to the pressure injury staging system include guidance on differential diagnoses for deep tissue pressure injury (DTPI). Accurately identifying DTPI is critical; however, purpura in the setting of vascular disorders and systemic infectious processes can share similar features confounding diagnosis. CASES: In this three-case series, we describe suspected DTPI with an uncharacteristic shape or occurring in the presence of additional lesions distributed outside of typical pressure areas prompted further evaluation. CONCLUSIONS: The interdisciplinary approach we adapted was useful in determining the cause of purpura when the DTPI was ruled out by the certified wound care nurse.

An 'inflammatory' variant of solar purpura: a simulant of leukocytoclastic vasculitis and neutrophilic dermatoses.

AIMS: To study the clinical and pathological features of cases of apparent solar purpura, with attention to the recently described phenomenon of inflammatory changes within otherwise typical lesions. METHODS: We studied 95 cases diagnosed as solar purpura and identified 10 cases (10.5%) in which significant neutrophilic inflammation was present, potentially simulating a leukocytoclastic vasculitis or neutrophilic dermatosis. An additional three cases were identified in subsequent routine practice. The clinical features, including follow-up for subsequent development of vasculitis and histological features were studied. RESULTS: In all cases the histological features were typical of solar purpura, with the exception of inflammatory changes, typically associated with clefting of elastotic stroma. Clinical follow-up information was available for all patients and none developed subsequent evidence of a cutaneous or systemic vasculitis or neutrophilic dermatosis. CONCLUSIONS: Inflammatory changes appear to be more frequent in solar purpura than is generally recognised. Awareness of this histological variation and correlation with the clinical findings and evolution is important in avoiding misdiagnosis.

Pigmented purpuric dermatosis: classification by phenotypic and molecular profiles.

The categorization of pigmented purpuric dermatosis (PPD) as a form of cutaneous lymphoid dyscrasia has been suggested. Phenotypic and molecular studies were done on 43 patients with PPD. The molecular studies used a capillary gel electrophoresis T-cell receptor beta multiplex polymerase chain reaction assay. There were 2 principal categories: polyclonal PPD represented by 22 cases and monoclonal variants comprising 21 cases. Monoclonal cases had extensive skin lesions. An identical restricted T-cell repertoire independent of time and location was observed. Approximately 40% of the monoclonal cases had clinical and pathologic features of mycosis fungoides (MF). In the polyclonal variant, disease outside the lower extremities was uncommon; there were no patients with MF. Striking reductions in CD7 and CD62L were seen in both groups. PPD is a form of cutaneous T-cell lymphoid dyscrasia, based on the frequency of monoclonality, the preservation of persistent T-cell clonotypes, and extent of pan-T-cell marker loss. Stratification of lesions of PPD according to the molecular profile may be of significant value prognostically and influence therapeutic intervention.

Life-threatening purpura and vasculitis.

Palpable purpura, the inflammation of blood vessels is the hallmark of vasculitis. It can be observed in a variety of settings, where vessels can be affected primarily or as a secondary event. Every patient with vasculitis should be considered to have a systemic disease unless proven otherwise. One or more systemic symptoms occur in at least 50% of patients and there is no way to predict systemic involvement. Patients may demonstrate mild systemic involvement like arthralgia and arthritis, fever and malaise or more severe symptoms such as massive proteinuria and raised creatinine leading to chronic renal failure, severe intestinal bleeding or perforation with a fatal outcome. In this article we will review the life-threatening aspects of purpura and vasculitis.

Anemia de Fanconi tipo Estren-Damashek / Anemia Fanconi type Estren-Damashek

Se presenta el caso de un niño de 12 años con astenia, adinamia y pérdida de peso de 2 meses de evolución, acompañado de petequias y un episodio de epistaxis no relacionado con traumatismo. La demostración de anemia aplásica sumado a la rotura cromosómica inducida por agentes clastrógenos (diepoxibutano) permitió el diagnóstico de Anemia de Fanconi (AF), que ante la falta de anormalidades físicas congénitas se clasificó como tipo Estren-Damashek, una variante muy inusual de este tipo de anemia

The differential diagnosis of purpura from a morphologic perspective.

Diseases associated with purpura range from the most common and trivial of human afflictions to some of the most devastating and rapidly fatal syndromes known. In order to sort the simple from the sinister, it is necessary to use not only the history and general physical examination, but also various morphologic components of the purpuric lesions themselves to suggest likely pathophysiologies of hemorrhage. Findings such as erythema, livedo reticularis, size of hemorrhage, presence or absence of palpability, symmetry or retiform patterning of lesions, and presence and extent of necrosis or eschar formation all can serve as clues to the likely etiologies of hemorrhage. Effective communication about purpuric syndromes requires information regarding the likely age of lesions described clinically or histologically and a precise description of the individual elements of the lesion. Such communication would be enhanced by eliminating the ambiguity inherent in the current usage of many of the terms employed to describe such lesions. This paper presents one possible approach to better use of the information that the morphology of purpuric lesions can provide.

Angioma serpiginoso: a propósito de un caso / Angioma serpiginosum: case report

Presentamos un caso de Angioma serpiginoso(AS) en una niña de 8 años de edad, debido a la infrecuente aparición de esta enfermedad. El cuadro clínico y los hallazgos histopatológicos cumplen con los criterios diagnósticos propuestos. Se comentan los distintos aspectos de la entidad, con mayor énfasis en lo referente al diagnóstico diferencial con la Púrpura Pigmentosa Crónica, el Angioqueratoma Circunscripto Neviforme y el Nevus Flammeus

Angioma serpiginoso: a propósito de un caso / Angioma serpiginosum: case report

Presentamos un caso de Angioma serpiginoso(AS) en una niña de 8 años de edad, debido a la infrecuente aparición de esta enfermedad. El cuadro clínico y los hallazgos histopatológicos cumplen con los criterios diagnósticos propuestos. Se comentan los distintos aspectos de la entidad, con mayor énfasis en lo referente al diagnóstico diferencial con la Púrpura Pigmentosa Crónica, el Angioqueratoma Circunscripto Neviforme y el Nevus Flammeus

Dermatopathology of skin necrosis associated with purpura fulminans.

Dermal vascular skin necrosis is associated with a complex group of clinical disorders. Many of these disorders are associated with an underlying abnormality of the PC anticoagulant system or DIC, or both. The clinical appearance and histopathologic features of dermal vascular skin necrosis are similar regardless of the etiology. Acute infectious purpura fulminans is distinct in that an acute vasculitis may be present in addition to microvascular thrombosis. Skin biopsy is a valuable diagnostic tool in the early recognition of these clinical disorders, since skin involvement is frequently an early manifestation of the disease process. Prompt recognition and institution of appropriate therapy at the reversible stages of dermal vascular thrombosis will, it is hoped, reduce the morbidity and mortality currently associated with skin necrosis and purpura fulminans.