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Palpable purpura and a visible sock line
Emi Ponce de Souza1, Richard P Usatine
1University of Texas Health Sciences Center at San Antonio, Department of Family and Community Medicine, San Antonio, TX 78229-3900 USA.
The Journal of Family Practice
|June 9, 2005
Summary
A young woman developed a painful purpuric rash after taking clindamycin for pharyngitis. This case highlights a potential drug-induced vasculitis, emphasizing the need for careful medication review in patients with new skin lesions.
Area of Science:
- Dermatology
- Internal Medicine
- Pharmacology
Background:
- A 21-year-old woman presented with a sudden onset of painful purpuric rash on her lower extremities.
- She had recently been prescribed clindamycin for pharyngitis due to multiple drug allergies.
Observation:
- The rash, characterized by purpuric papules, was primarily located on the lower extremities, with a distinct linear distribution around the calves.
- The patient experienced pain and swelling in her legs, and urinalysis revealed hematuria without proteinuria.
Findings:
- The clinical presentation and history suggest a diagnosis of drug-induced hypersensitivity vasculitis, possibly triggered by clindamycin.
- The lesions' distribution, particularly the demarcation at the sock line, warrants further investigation into pressure-induced phenomena or localized reactions.
Implications:
- Prompt diagnosis and discontinuation of the offending drug are crucial for managing hypersensitivity vasculitis.
- This case underscores the importance of considering drug reactions in the differential diagnosis of purpuric rashes, even with atypical presentations.