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Question: Rash

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A 19 year old otherwise well-appearing man presents with 2 days of headache, anorexia, tactile fever (but afebrile in the ED), and 1 day of palpable purpura on bilateral lower legs. Which of the following is true?

19yo well appearing palpable purpura on legs - which is true?

pemsou5_wp • April 3, 2019

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  1. Kelly April 3, 2019 - 12:32 pm Reply

    C) This entity sometimes presents with joint pain and no rash
    The patient described is presenting with Henoch-Schonlein-Purpura (HSP), an IgA-mediated vasculitis which is more common in children 3-15 years, but can occur in adults. Headache, anorexia, and fever are common prodromal symptoms, and > 95% will develop the classic rash of palpable purpura primarily affecting the legs. However, some patients can have arthralgias that precede the rash, prompting misdiagnosis. Renal disease and failure is the most common serious complication. Abdominal pain, vomiting, intussusception, gastrointestinal bleeding, and scrotal pain and swelling are other common complications. Platelet count is normal, differentiating from thrombocytopenic conditions, which are unlikely to present with findings on the legs only. Meningococcemia might present with fever, headache, and purpura, but the patient would not be well appearing.

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