2017.4-39.purpura


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Meghwal B, Balai M. Post-vomiting purpura. Our Dermatol Online. 2017;8(4):505-506.

 

 
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Post-vomiting purpura

Badrilal Meghwal1, Manisha Balai2

1Department of Pediatrics, RNT Medical College, Udaipur, Rajasthan, India2Department of Dermatology, RNT Medical College, Udaipur, Rajasthan, India

Corresponding author: Dr. Badrilal Meghwal, E-mail: drblmeghwal@gmail.com

Submission: 01.11.2016; Acceptance: 06.07.2017

DOI: 10.7241/ourd.20174.146


Sir,

We report a case of 7-year-old female child who presented with multiple, asymptomatic, purpuric lesions over face after a single episode of forceful vomiting. On examination the lesions were purpuric but not palpable. They were localized to bilateral periorbital regions (Fig. 1), slightly extending to the cheeks. (Fig. 2). The child was otherwise healthy and there was no previous history of any similar lesions in the past in the patient or his family. There were no skin lesions elsewhere, including mucosa. There was no history of any trauma, fever and sun exposure. There was no history of drug intake.

Figure 1: Purpuric lesions bilateral periorbital area after vomiting.
Figure 2: Left lateral view showing purpuric lesions extending to cheek.

 

Laboratory investigations including complete blood count, bleeding time, clotting time, and prothrombin time were normal. The lesions subsided without treatment within a period of seven days.

We present this case to highlight the rare but definite entity called post-vomiting purpura. Purpura/petechie around the eyelids are classically seen while performing the Valsalva manoeuvre, but in practice they are more likely after severe coughing or vomiting, and also described after endoscopy [1,2]. The aetiology is a sudden rise in the venous and capillary pressure in the head and neck caused by a rise in intrathoracic pressure during vomiting. The lesions are self-resolving and no specific intervention other than patient counseling is required [3,4].

REFERENCES

1. Kaliyadan F, Kuruvilla JP. Post-vomiting purpura. Indian Dermatol Online J. 2016;7:456-7.

2. Cox NH and Piette WW. Purpura and Microvascular Occlusion. In: Rook’s Textbook of Dermatology. Burns T, Breathnach S, Cox N, Griffiths C editors. Blackwell Publishing; 2010. pp 49.4-5.

3. Burke M, Marks J. Purpura associated with vomiting in pregnancy. Br Med J. 1973;2:48.

4. Pitt PW. Purpura associated with vomiting. Br Med J. 1973;2:667.

Notes

Source of Support: Nil

Conflict of Interest: None declared.


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