Suggest Treatment For Spreading Petechial Rashes On The Ankle
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?
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