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Middle Aged Male with Large Bruises
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Visual Journal of Emergency Medicine 4C (2016) 11–12 www.elsevier.com/locate/visj
Middle Aged Male with Large Bruises Derek Isenberg, MDn, Raluca Isenberg, RN Department of Emergency Medicine, Crozer-Chester Medical Center, Chester, PA
Keywords: idiopathic thrombocytopenic purpura; ecchymosis; thrombocytopenia
Visual Case Discussion A 42-year-old male with no past medical history presented with 3 months of easy bruising and a rash on his lower legs. Over the past week, he noticed bleeding from his gums. His primary care doctor had performed outpatient lab work and sent him to the emergency department. On examination, the patient had no complaints. Vitals signs were as follows: oral temperature 98.91C, heart rate 68 beats per minute, respiratory rate 12 breaths per minute, and blood pressure 138/62. Physical examination revealed a well-developed male in no distress. His skin examination showed large bruises on his right chest wall, left shin, and right shin. There was a non-blanching rash on the bilateral lower extremities as pictured in the Figure. Other than his skin exam, the remainder of his physical examination was normal. A complete blood count revealed hemoglobin of 12 g/l (normal: 11–14 g/l), white blood cell count of 7.3 103/mm3 (normal: 4–10 103/mm3), and a platelet count of 6 103/mm3 (normal: 150–400 103/mm3). All other lab work was normal. The photo demonstrates a petechial rash with large ecchymosis. The normal lab work, except for the platelets, is consistent with the diagnosis of idiopathic thrombocytopenia purpura.
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Corresponding author. E-mail address: [email protected] (D. Isenberg).
http://dx.doi.org/10.1016/j.visj.2016.02.005 2405-4690/& 2016 Elsevier Inc. All rights reserved.
12
D. Isenberg, R. Isenberg / Visual Journal of Emergency Medicine 4C (2016) 11–12
Fig. Photograph of patient's lower extremity.
Appendix. Supplementary Information Supplementary data associated with this article can be found in the online version at http://dx.doi.org/10.1016/j. visj.2016.02.005. References [1] Kappler S, Ronan-Bentle S, Graham A. Thrombotic microangiopathies. Emerg Med Clin North Am 2014;23(32)649–71.
Available online at www.sciencedirect.com
Visual Journal of Emergency Medicine 4C (2016) 11–12 www.elsevier.com/locate/visj
Middle Aged Male with Large Bruises Derek Isenberg, MDn, Raluca Isenberg, RN Department of Emergency Medicine, Crozer-Chester Medical Center, Chester, PA
Keywords: idiopathic thrombocytopenic purpura; ecchymosis; thrombocytopenia
Visual Case Discussion A 42-year-old male with no past medical history presented with 3 months of easy bruising and a rash on his lower legs. Over the past week, he noticed bleeding from his gums. His primary care doctor had performed outpatient lab work and sent him to the emergency department. On examination, the patient had no complaints. Vitals signs were as follows: oral temperature 98.91C, heart rate 68 beats per minute, respiratory rate 12 breaths per minute, and blood pressure 138/62. Physical examination revealed a well-developed male in no distress. His skin examination showed large bruises on his right chest wall, left shin, and right shin. There was a non-blanching rash on the bilateral lower extremities as pictured in the Figure. Other than his skin exam, the remainder of his physical examination was normal. A complete blood count revealed hemoglobin of 12 g/l (normal: 11–14 g/l), white blood cell count of 7.3 103/mm3 (normal: 4–10 103/mm3), and a platelet count of 6 103/mm3 (normal: 150–400 103/mm3). All other lab work was normal. The photo demonstrates a petechial rash with large ecchymosis. The normal lab work, except for the platelets, is consistent with the diagnosis of idiopathic thrombocytopenia purpura.
n
Corresponding author. E-mail address: [email protected] (D. Isenberg).
http://dx.doi.org/10.1016/j.visj.2016.02.005 2405-4690/& 2016 Elsevier Inc. All rights reserved.
12
D. Isenberg, R. Isenberg / Visual Journal of Emergency Medicine 4C (2016) 11–12
Fig. Photograph of patient's lower extremity.
Appendix. Supplementary Information Supplementary data associated with this article can be found in the online version at http://dx.doi.org/10.1016/j. visj.2016.02.005. References [1] Kappler S, Ronan-Bentle S, Graham A. Thrombotic microangiopathies. Emerg Med Clin North Am 2014;23(32)649–71.