Puzzle out the cause of an unusual bruise on the ankle of a young boy in this slide show based on a true story.
Your pediatric hematology colleague asks you to see a young boy with concerning bruising that may or may not be a malignancy or bleeding disorder.
The 7-year-old boy's "rash" is of 3 months' duration. Screening CBC was normal. Malignancy can not yet be ruled out.
Past medical history, family history, and review of systems are all non-contributory. The child is also completely asymptomatic.
Pertinent findings: Reddish-brown macular lesion over area of distal right fibula and ankle. Non-palpable petechiae on periphery of lesion.
Possible diagnoses? Not a malignancy; not classic Henoch-Schonlein purpura; not fixed drug eruption; bruising is persistent...
Differential diagnosis: Schamberg disease. pigmented purpuric lichenoid disorder; purpura annularis telangiectodes (Majocchi disease); lichen aureus; atypical Henoch-SchÃ¶nlein purpura; eczematoid-like purpura.
Schamberg disease: one of the pigmented purpuras; all are considered capillaritis; hemosiderin-laden macrophages seen on histology.
Schamberg disease: benign, chronic, can occur at any age; 5 times more common in males; lesions are red-brown punctate ("cayenne pepper spots).
The pigmented purpuras: Schamberg disease, pigmented purpuric lichenoid disorder (PPLD) of Gougerot and Blum; purpura annularis telangiectodes (Majocchi’s disease); lichen aureus; eczematid-like purpura of Doucas and Kapetankis (itching purpura).
An otherwise healthy 7-year-old boy has an odd "rash" on one ankle. The pediatric hematologist has ruled out a number of malignancies and bleeding disorders. The parents are very anxious to find out what's wrong. And now they bring him to you.In these slides, follow Dr Jonathan Schneider's typically cautious, consistently thorough process to puzzle out the cause of the unusual bruise.
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