Question: I am desperate. My brother is 60 has hep c, RA, on lactolos, methadone. just off Embril for RA. about 3 weeks ago he visited a podiatrist (mistake) because his feet were very dark purple up to his ankles. we did not know what this was - his Gastro said that the blood pools like this in some people, his Ortho said that the black was a fungus...funny thing we had been asking both of them about these black feet for 2 years. so the Podiatrist gave him gamapenten - 4 pills later both of my brothers legs blew up into a huge rash - looked like celulitis. ortho gave him antibiotic and it cleared up in 10 days. a week later it came back with a vengence. now he is not only inflamed but retaining fluid - swollen. his mind seems to be going. he is foggy weak. the Gastro prescribed diuretics and they don't seem to be working. he just tried to eat and went into a hip up spasm. I am just about hysterical with fear. the gastro told us to go to a dermotologist - but they are so backed up - I am trying to get in. emailing you in the meantime. I could text you a photo. Gastro says not cellulitis because he has no fever and it is both legs. help me. what the heck do you think this is- I feel like he is dieing.

I will try to do this tomorrow and thank you -

how do I upload the photos please - I have 4 of them - sorry we had a graduation party last night. my brother was here and i honestly don't know how he made it. the day was horrid. he is also taking Morphine for pain and had reduced his dosage until this "rash" occurred. he was very out of it all day but that could be due to his liver issues and hep c too. I've seen him like this before he started taking his Lactolose. so I have the photos - need to download them asap. thank you Doctor - of course I am going to try to get him in next week to a Dermatologist - but they are so backed up here. I might have a Doc that can get him in - but you never know. Please excuse my spelling. OK - I figured out how to download the photos - I sent you 4 photos. I sincerely hope you can figure this out. My brother said that when he looks on line it almost seems like the symptoms of polio. of course his immune system is shot due to taking embril for at least a year for his RA. the Ortho doc said she thought that when his feet were blackish (for almost 2 years) that is was a fungus and now this red is a manifestation of this. Gastro Doc says - no it never was a fungus but a pooling of blood. Podiatrist RX's Gabapentin and after 4 pills brother broke out in this the first time - and now again with a vengeance. help me please. what do you think this is???

Wow. I'm not so sure this is correct - he is NOT asymptomatic. His legs are swollen - retaining fluid. He says they are very painful. He can hardly walk. with that input - what would be your other diagnosis? we had to use a wheelchair yesterday to get him to the graduation. i just don't think this is it. we know it is not related to the cyrosis of the liver, the doc did not think it was an reaction to the gabepentin and the Morphine combination (what do you think about that? he did break out after taking 4 of the gabepentin)I just looked it up - this sure looks like it and there was reference to hepititis also and RA....maybe my brother is just imagining he is in pain around this and it is really his RA that is flaring up do to not being able to take Embril or Humara. so there is nothing we can do about this....it just runs its course. do you have any idea why prior to this his feet and ankles were blackish/purple? I really appreciate this. don't give up on me here - this is very helpful and of course we will go to a derm when we can get in.

ok - we will do this color doppler - he had an ultrasound last week - is the doppler yet another diagnostic that would be valuable in addition to this? Another question - don't you think this could possibly be brought on by the Gabapentin RX? I really think it was - brother burst out with this rash 4 pills into taking Gabapentin. Site states "Hypersensitivity to an unknown causal agent"."Drug eruption". "Any suspected precipitants should be withdrawn." (which we did immediately). he still states it is painful and then of course the swelling is horrendous. his feet look like they are going to burst. the photos that I sent you were the day prior to the swelling that came on board the next day and has remained even with the diuretics that were RX'd. if I can get a photo of the swelling I'll send that to you too.

Oh my! this is IT! the first time he broke out the ortho doc RX'd antibiotic AND Steroid and he cleared up almost magically in about 9 - 10 days. this time ortho doc only RX'd Antibiotic (no steroid) and he is not clearing up. The Gastro stated - ".....well, finish the Antibiotic course - it won't hurt you - but I really don't think it will help you either" Gastro was correct. He then wanted a consult with a Dermo and of course getting into a Dermo in this town is impossible. thank God I found you! I am going down this afternoon to photograph my brothers legs and feet - that are so swollen you won't believe it. I wonder if he should stop the diuretic? because it certainly is NOT reducing the swelling. I can get the Ortho to order more steroids tomorrow if you think that your second opinion is more on the mark...and believe me, it totally believe that it is right on!!! THANK YOU! (stop the diuretic?) Photos to come this afternoon. I am so grateful for your time!!

PS - if it is "drug induced small vessel vasculitis" will this continue to haunt my brother ongoing or can there be a resolution at some point?

did you receive the photos and my last long email sent a couple of minutes ago?

i guess my last long email did not go through. Correction regarding steriods: Brother NEVER took steriods to clear this up - I imagine the Ortho felt that steriods might be dangerous with his hep c and RA. Gastro sort of alluded to this too. but last time this rash cleared up with Dicloxacillin 500mg 10 day course. this time he is on a 14 day course. Rash looks better and so does swelling today. you can see the pitting were I pressed with my finger. brother is a candidate for Sovaldi for his Hep c - but he has to be clear of this 'drug induced small vessel vasculitis' first. Brother is upping his methadone to manage horrid pain. he was down to 1 per day - now up to 3 per day 10mg and this affects his thinking and ability the converse and be clear. it is heartbreaking - but the pain is so bad. even his thighs hurt. gastro RX's Spironolactone 50mg and Fuosemide 20 mg diuretics to lower swelling.

But what about the sever pain and the sudden onset? This does not go along with what you said about the difference between Schamburg's purpura and 'drug induced small vessel vasculitis' (pronounced swelling, sudden appearance of the rash and temporal relation to gabapentin). Why are you now thinking Schamburgs again?

ok - this makes sense to me. can I leave this discussion open for a bit please. I think I am about finished but am fearful of letting you go just yet.

I will check and see if a defect of coagulation has been ruled out. This consult is just amazingly helpful.

i am going to close this now. I have never had such a thorough consultation - even face to face with a doctor. My father was a doctor and my mom is a nurse. they are very old and I often need support in reaching out to docs. I will use this site often. YOU DR S - are amazing, compassionate, patient and provided attention to many details. thank you from the bottom of my heart. we have an appointment with a primary tomorrow and hope for a referral to a dermo soon. but I will share your input regarding my brothers legs with the primary. I will hit the close button in a minute - but want to make sure I don't lose any of this report