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Suggest Treatment For Spreading Petechial Rashes On The Ankle

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Posted on Mon, 26 Dec 2016
Question: I've had a Petecial Rash for just over two months and it is slowly spreading. I first noticed a few dots on the outside of my left ankle and assumed it was from spraining my ankle or the wrap I was using. It quickly spread across both ankles (inside and out...outside is much worse) and up the shins and across the tops of my feet. After a month I had what I'm assuming was 5 days of unrelated morning chest pressure and elevated Blood pressure and went to a walk in clinic and the Doctor sent me straight to ER to rule out Endocarditis, Atrial Fibrilation and heart attack. ER didn't say much about the rash but said my EKG was fine and set me up to get a Holter test. (No results yet) .

Two weeks later my chest pressure was gone but the rash was still spreading so I went to another walk in clinic and the Doctor said it was Hemograghic (sic?) Purpura. He ordered a CBC with Differential and a Pt-INR test and said "we need to find out why you are bleeding". I saw the results online and they seemed normal and the Doctor never called so I'm assuming I read the labs correctly.

I went back to the first Walk in Clinic this past week and a 3rd Doctor called it a Petechial rash and order CBC w. Diff, a CRP test and both a Pt-inr and an aPPT test- again, everything looks fine from what I could tell. He also swabbed the area and labs came back normal (from what I read). I'm seeing a Dermatologist in January but just thinking if something was wrong it would have shown up on these tests. Today, it was up my left thigh and on both biceps and is still really bad on my feet, ankles and shins. Other than swollen lymph nodes for the past month I'm pretty much healthy and don't feel sick. No fever or aches. I had a few months of bad night sweats in the late spring and Summer (despite having the coldest and best air conditioner) but that went away. I'm in decent shape but I smoke, age 44. Zoloft is the only prescription and I've been taking that since 2002. I don't have a Family Doctor since moving.
All of the Petechiae is flat except the ones right behind my ankle, those you can feel. I assumed this was vasculitis but my CRP was .7 out of a <5 range. Any thoughts on why this is suddenly occurring after 44 years? Should I bother going to the dermatologist?
doctor
Answered by Dr. Tushar Kanti Biswas (5 hours later)
Brief Answer:
Purpura

Detailed Answer:
Hi,

Thank you for your query. I can understand your concerns.

It seems you are having Palpable purpura or non-thrombocytopenic purpura.
Leukocytoclastic vasculitis (LCV), is the one most commonly associated with palpable purpura.Underlying etiologies include drugs (e.g., antibiotics), infections (e.g., hepatitis C virus), and autoimmune connective tissue diseases (e.g., rheumatoid
arthritis, Sjögren’s syndrome, lupus).
At your age one should rule out connective tissue disorder.A screening test like serum ANA( Anti-nuclear antibody ) would be justified.
A skin biopsy of some purpuric lesion including fluorescence study would confirm/rule out leukocytoclastic vasculitis .
Go for a high-sensitivity CRP (hs-CRP) test which measures low levels of CRP with a sensitivity down to 0.04 mg/L (yours is 0.7).
It is time to leave your family doctor and visit a dermatologist.
Leukocytoclastic vasculitis (LCV) responds to steroid (often dramatic resolution)















Regards

Dr. T.K. Biswas M.D. XXXXXXX


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Above answer was peer-reviewed by : Dr. Veerisetty Shyamkumar
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Answered by
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Dr. Tushar Kanti Biswas

Internal Medicine Specialist

Practicing since :1975

Answered : 1920 Questions

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Suggest Treatment For Spreading Petechial Rashes On The Ankle

Brief Answer: Purpura Detailed Answer: Hi, Thank you for your query. I can understand your concerns. It seems you are having Palpable purpura or non-thrombocytopenic purpura. Leukocytoclastic vasculitis (LCV), is the one most commonly associated with palpable purpura.Underlying etiologies include drugs (e.g., antibiotics), infections (e.g., hepatitis C virus), and autoimmune connective tissue diseases (e.g., rheumatoid arthritis, Sjögren’s syndrome, lupus). At your age one should rule out connective tissue disorder.A screening test like serum ANA( Anti-nuclear antibody ) would be justified. A skin biopsy of some purpuric lesion including fluorescence study would confirm/rule out leukocytoclastic vasculitis . Go for a high-sensitivity CRP (hs-CRP) test which measures low levels of CRP with a sensitivity down to 0.04 mg/L (yours is 0.7). It is time to leave your family doctor and visit a dermatologist. Leukocytoclastic vasculitis (LCV) responds to steroid (often dramatic resolution) Regards Dr. T.K. Biswas M.D. XXXXXXX