1/7. Acute scrotal swelling in Henoch-Schonlein purpura: a case report.Henoch-Schonlein purpura is a systemic vasculitis and sometimes presents as acute scrotal swelling in children. We report a case of Henoch-Schonlein purpura with acute scrotal swelling, which was correctly diagnosed based upon local physical findings. Scrotal ultrasonography showed normal testes and hydrocele testis around the affected testis 3 hours after the sudden onset of the pain. The scrotal symptoms improved in 2 days with steroid therapy. Scrotal ultrasonography was useful to diagnose Henoch-Schonlein purpura with scrotal involvement. Steroid treatment appeared to be effective for this condition.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/7. An idiopathic skin eruption resembling a butterfly rash in a septic patient with disseminated intravascular coagulation following bone marrow transplantation.A 31-year-old man who underwent chemotherapy and bone marrow transplantation to treat acute myeloblastic leukemia was admitted to our department complaining of high fever and hypotension. His physical examination revealed warm shock state, eruptions resembling that seen in systemic lupus erythematosus on his face and cyanosis in his fingers. We diagnosed septic shock and idiopathic skin eruption on his face. Following treatment with blood transfusion, anticoagulant, antibiotics, respirator and continuous arteriovenous hemofiltration and dialysis, the patient's condition gradually improved. The eruptions on his face first observed at admission progressed with a worsening of his disseminated intravascular coagulation (DIC), and subsided with an improvement in his DIC. A biopsy of the eruption was taken and pathological findings of the eruption revealed multiple micro-fibrin depositions of the dermis. The skin necrosis in purpura fulminans often begins in the distal extremities. But our patient developed this uncommon skin eruption on his face. patients with an idiopathic skin eruption resembling a butterfly rash in a septic patient should be considered to complicate DIC as in the present case.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/7. Perforated appendicitis in a child with Henoch-Schonlein purpura.Henoch-Schonlein purpura (HSP) is a common childhood vasculitis. abdominal pain is a common feature of HSP, often leading to surgical consultation for evaluation of possible intussusception. appendicitis is a rare complication of HSP, and in each of the 3 reported cases, appendectomy preceded the appearance of the purpuric rash. More often, unnecessary laparotomies are performed on patients in whom appendicitis is suspected, but who subsequently develop the characteristic purpura. This is the first reported case of appendicitis developing in a patient with the established HSP rash. This case is also the first report of perforated appendicitis in HSP. Clinical vigilance and serial physical and ultrasonographic examinations are needed to detect conditions necessitating surgery in patients with HSP.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/7. Palpable purpura and a visible sock line.A 21-year-old woman came to the clinic, frightened by a painful purpuric rash on her lower extremities. The lesions appeared suddenly 3 days before, with no prior similar episodes. The pain, and some swelling that happened when she stood, had finally driven her to take some time off from her job and seek medical advice. She was diagnosed with a case of pharyngitis earlier that week; due to multiple drug allergies, she was prescribed a course of clindamycin. She had not experienced any nausea or vomiting, fever, abdominal cramping, or gross hematuria. On examination, the patient was friendly and good-humored, although she was concerned about her rash and visibly uncomfortable. She was walking with the aid of a borrowed cane, but her lesions were no longer tender to palpation. The rash consisted mainly of purpuric papules almost entirely limited to her legs, although some isolated lesions were on her back as well. The papules were concentrated around her distal lower extremities, with a clear line of lesions encircling her calves bilaterally where her knee-high socks had applied pressure for the last 2 days. Mild edema was noted, but the rest of her physical exam was normal. By dipstick, the patient had blood in her urine but no protein. What is the diagnosis? What is the treatment for this condition?- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/7. Acute testicular pain: Henoch-Schonlein purpura versus testicular torsion.A skilled examiner may not be able to exclude testicular torsion by physical examination maneuvers in a patient who presents with acute scrotal pain. Diagnostic adjunctive studies may be of assistance. However, if a diagnosis cannot be established with certainty, surgical exploration is warranted. patients with Henoch-Schonlein purpura who present with a vascular eruption on the scrotum, lack a rash elsewhere, and have no arthritis or hematuria are likely to be explored.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
6/7. Radionuclide scrotal imaging in anaphylactoid purpura.Tc-99m pertechnetate radionuclide scrotal scanning was performed on nine hospitalized boys with anaphylactoid purpura and acute scrotal tenderness. Scrotal involvement in anaphylactoid purpura is generally a part of the basic pathological process (i.e., vasculitis). Sometimes testicular torsion could not be excluded by physical examination. Tc-99m radionuclide scan was proven to be a useful tool, enabling distinction between the two processes. In all the patients the scan showed increased flow to the scrotum, compatible with inflammation of the scrotal wall and normal testicular perfusion, ruling out testicular torsion. All the boys were treated conservatively, with rapid resolution of the scrotal symptoms.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
7/7. Henoch-Schonlein purpura: a diagnosis not to be forgotten.Henoch-Schonlein purpura (HSP) is a systemic, generalized vasculitis of unknown etiology thought to be related to an IgA-mediated autoimmune phenomenon. diagnosis is based on a constellation of physical findings that include the characteristic nonthrombocytopenic petechial or purpuric rash, migratory polyarthralgias, abdominal pain, and renal complications. We report the case of a 19-year-old man with a diagnosis of HSP who had severe abdominal pain and endoscopic documentation of duodenal involvement. Though not clear at presentation, the diagnosis became obvious when the characteristic rash emerged.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |