A 16-year old previously healthy, morbidly obese male patien | Figure 1

BorisJ87
Infectious Diseases

A 16-year-old previously healthy, morbidly obese male patient presented in my office with a 2-day history of mild sore throat and one day history of skin rash on his lower legs which started that morning and during the day expanded to involve upper legs, abdomen and lower arms (no image available) which is "burning" in quality. He has no other symptoms. His PHx and SEHx are unremarkable.

On physical exam I noticed this purpuric rash which in his lower legs has necrotic appearance with central spots of pustules. On other areas is only purpuric. He didn't have mucosal lesions. The rest of the exam was unremarkable.

I gave a provisional diagnosis of necrotic vasculitis (leukocytoclastic type) and sent the patient to the dermatologist. I was also thinking about Henoch-Schonlein purpura.

What is your opinion?

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