Petechiae & Purpura
Petechiae
A pinpoint, nonraised, perfectly round, purplish red spot caused by intradermal or submucous haemorrhage. Petechiae information and photos here and here.
Tick Borne Disease Relationship- Petechiae
Parvovirus B19 has been described recently to cause generalized petechiae. The differential diagnosis includes allergic contact dermatitis, rickettsial infections and Kawasaki disease. Treatment is symptomatic, and diagnosis can be made clinically or serologically.
Am J Med. 1986 Jul;81(1):153-7.
Rocky Mountain spotted fever presenting as thrombotic thrombocytopenic purpura.
Turner RC, Chaplinski TJ, Adams HG.
Abstract
A patient presented with findings compatible with thrombotic thrombocytopenic purpura. The diagnosis of Rocky Mountain spotted fever was also considered because the patient was a hunter in a tick-infested area. He was treated for both diagnoses. The patient recovered and a diagnosis of Rocky Mountain spotted fever was confirmed by serologic methods. Clinical symptoms and hematologic parameters of severe Rocky Mountain spotted fever may resemble thrombotic thrombocytopenic purpura, implying that there may be similarities in the pathophysiology of both disorders.
Purpura
Purpura, which is also known as skin hemorrhages and blood spots, is a rash which appears as an outbreak of red dots on the skin. A purpura rash can appear anywhere on the body, but it more commonly appears in specific areas such as the front of the lower legs, or the outer sides of the lower arms.
The direct cause of purpura is blood in the skin which has leaked from blood vessels, which is what makes the little purplish-red dots or blisters to appear.
This bleeding can be the result of several different causes. One common cause is that the platelet count in the bloodstream becomes low enough that bleeding can occur. Another possible explanation is that there is some sort of damage to the blood vessels, which can be exacerbated by fragile or thin blood vessels. It is also possible that some sort of inflammation causes the blood vessels to swell. Ultimately, there are a wide variety of possible explanations for purpura.
In some cases, a spreading rash may be a sign of severe infection, or leukemia, or even meningitis, so a doctor should always be consulted to diagnose the exact cause. Purpura photo, click here.
Tick Borne Disease Related Purpura
Immun Infekt. 1988 Feb;16(1):15-7.
[Schoenlein-Henoch purpura in Borrelia burgdorferi infection]. Schlotfeldt D, Fahrenkrug H. Internistische Praxis, Hamm.
In a 24-year-old patient suffering from recurrent purpura Schoenlein-Henoch, there were found positive Lyme-spirochete IFT. Due to the motion of titres in immune fluorescence examinations the purpura seems to be likely one form of a late manifestation in borrelia infection.
Dtsch Med Wochenschr. 1988 Jul 1;113(26):1061-3.
[Thrombocytopenic purpura caused by Borrelia burgdorferi?].
Schneider T, Lange R, Niederhut D.
Institut für Angewandte Zoologie, Berlin.
In November 1983 a woman born in 1902 was found to have thrombocytopenic purpura with a platelet count of 14,000/microliter. Examination of the sternal marrow resulted in a suspected diagnosis of Werlhof's disease. Platelet counts dropped at times to below 7,000/microliter during immunosuppressive treatment with corticosteroids and azathioprine of three months' duration.
When this treatment was discontinued spontaneous remission occurred until July 1984. Acrodermatitis chronica atrophicans was diagnosed in August 1987. The IgG antibody titre against Borrelia burgdorferi of 1:2,000 in whole blood and the late manifestation of Lyme disease (chronic acrodermatitis atrophicans) suggest a causal relationship with the previous thrombocytopenic purpura.
Klin Padiatr. 1989 Mar-Apr;201(2):133-5.
[Clinical manifestation of Lyme borreliosis in childhood]. Huber A, Baumann W.
Kinderklinik der Johannes Gutenberg-Universität Mainz.
We report on 4 children with different clinical manifestations of Lyme-Borreliosis. One patient presented with a stage 2 typical aseptic meningitis and 2 others with symptoms of Schönlein-Henoch purpura and rheumatic disease respectively.
A further case had bilateral palsy of abducens nerve and unilateral palsy of trochlearis nerve which are described for the first time in Lyme-Borreliosis. Diagnosis was established by detection of specific antibodies to Borrelia in all patients. Differential diagnosis of these symptoms should include Lyme-Borreliosis.
Rev Infect Dis. 1989 Sep-Oct;11 Suppl 6:S1475-81.
Dermatologic manifestations of Lyme disease. Berger BW.
Department of Dermatology, New York University School of Medicine, New York.
Erythema migrams (EM), the distinctive cutaneous lesion of Lyme disease, has a variable clinical appearance, but at some point presents as a centrifugally expanding, usually erythematous, annular patch. Of 237 patients with this condition, 201 (85%) were examined initially from May through September.
Thirty-four (14%) remembered having been bitten by a deer tick. The median interval from the bite to the appearance of EM was 9 days (range, 1-36 days). Forty-one (17%) of the patients had multiple EM lesions.
Of the 237 patients, 128 (54%) manifested major extracutaneous signs and symptoms. Although EM also has a variable histologic picture, the presence of a deep and superficial perivascular and interstitial lymphohistiocytic infiltrate containing plasma cells is diagnostic.
Spirochetes can be demonstrated with Warthin-Starry staining in approximately 40% of the biopsy specimens. Concomitant cutaneous lesions appeared on some patients before and during antibiotic therapy.
Nine patients with serologic evidence of Borrelia burgdorferi infection had cutaneous lesions other than EM, including granuloma annulare (three), erythema nodosum (two), papular urticaria (two), Henoch-Schönlein-like purpura (one), and morphea (one). Whether these entities are cutaneous markers of Lyme disease or are coincidental findings is yet to be determined.
Severe Ehrlichia chaffeensis infection in a lung transplant recipient: a review of ehrlichiosis in the immunocompromised patient.
QUOTE- "We describe a case of human ehrlichiosis in a lung transplant recipient and review published reports on ehrlichiosis in immunocompromised patients.
Despite early therapy with doxycycline, our patient had unusually severe illness with features of thrombotic thrombocytopenic purpura.
Of 23 reported cases of ehrlichiosis in immunocompromised patients, organ failure occurred in all patients and 6 (25%) died." SOURCE