September 2021 - Case of the Month
A 24-year-old woman presented with a several year history of evolving 'lumps' especially on the central chest. The lady had mild facial acne and was otherwise well.
A 42 year old man was referred with a 6 week history of an asymptomatic rash affecting his lower abdomen, buttocks, lower legs and forearms. This was associated with some swelling and aching of his ankles and to a lesser extent his knees. There had been no preceding infection or other trigger. The patient also complained of occasional bouts of abdominal pain.
The patient had two previous episodes, the first in his late teens and the second one 10 years earlier, the latter went on for almost 15 months. In between episodes his skin was normal.
The patient was otherwise well and took no medication. He had an office based job and drinks a moderate amount of alcohol. There are no relevant hobbies.
OE there was a non-blanching red-purple macular rash.
What is the differential diagnosis?
The diagnosis was consistent with Henoch-Schonlein purpura (HSP). During all three occasions there had been no renal or other systemic involvement, although there was occasional abdominal pain.
HSP is defined as a small vessel vasculitis involving deposition of IgA immune complexes, that characteristically involves the skin, gastrointestinal system and glomeruli with or without arthritis or arthralgia. 90% of cases arise under the age of 10. Occasionally older children and adults are affected.
In the majority no trigger is found, although Group A beta-haemolytic streptococci is found in approximately 30% of cases.
Clinical features
Systemic features
Histopathology shows a leucocytoclastic vasculitis.
HSP is usually self-limiting, the main exception being those patients with moderate-severe renal involvement.
Refer to the chapter on vasculitis for more information.
A 24-year-old woman presented with a several year history of evolving 'lumps' especially on the central chest. The lady had mild facial acne and was otherwise well.
A 52 year old man presented with a one year history of skin lesions predominantly on his hands, ears and scalp. He was also complaining of painful swollen fingers associated with morning stiffness. There was no family history of skin or joint problem...
A 72 year old man was referred with a rash, predominantly on the legs. The patient was systemically well and the lesions were only mildly symptomatic. The lesions presented as one to several at a time lasting several weeks. They had not res...
Welcome back to the new look PCDS website, and our first case. This lady was referred as a 2-week wait with a changing lesion on the right temple.
A 15 year old lady was referred for a diagnostic opinion for skin changes presenting in birth, affecting the right upper back, shoulder, antecubital fossa and dorsal wrist. The patient was asymptomatic and otherwise well.
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