Bedside Diagnostic Challenge – A 59-year-old Woman with Multiple Red Spots on Her Legs

Paul Griner, MD, MACPBedside Diagnostic Challenge, Emergency Medicine, Family Medicine, Internal Medicine, Nurse Practitioner, Nursing RN/PN, Pediatric Medicine

red spots on legs of 49-year-old woman diagnostic challenge

Bedside Diagnostic Challenge

A 59-year-old woman presents to her primary care physician with the complaint of multiple red spots on her legs of 2 days duration.

A 59-year-old woman presents to her primary care physician with the complaint of multiple red spots on her legs of 2 days duration. She had been in good health with the exception of a lower urinary tract infection, treated with Fosfomycin, which had eliminated her urinary symptoms.

Physical examination reveals a somewhat uncomfortable appearing woman looking her stated age.

  • Temperature is 37.20 C
  • Blood pressure 142/80 mm Hg
  • Pulse 90/minute and regular
  • Respirations 16 per minute
  • Finger oximetry reading is 95% on room air

Abnormal findings are limited to the legs where there are multiple 3mm to 20mm slightly raised reddish purple lesions which do not blanch (see figure).

red spots on legs, purpura on lower extremities
Figure. Purpura involving the lower extremities (red spots on legs).

The lesions are slightly tender to palpation. Most are located between the knees and ankles.

The remainder of the physical examination is normal.

No similar lesions are noted in any location above the mid-thighs.

Question:

Based on the diagnostic value of careful examination...

Which of the following conditions do these lesions most closely resemble?

Answer Options:

Idiopathic thrombocytopenic purpura (ITP)

Thrombotic Thrombocytopenic purpura (TTP)

IgA vasculitis

Meningococcemia

See the Answer:


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About The Bedside Diagnostics Blog Series:

Except for Hospitalists, Emergency Medicine physicians, and Interventional Cardiologists, most physicians will spend the bulk of their professional time with patients in an office setting.

Here is where finely tuned clinical skills are most important in leading to accurate diagnoses, fewer complications resulting from unnecessary tests and procedures, and lower costs. These Bedside Diagnostic Challenges reinforces the value of these clinical skills and tests users on their knowledge of them.

Bedside Diagnostic Challenge questions are issued periodically every month as a free benefit of Med-Challenger.

Subscribe to the Med-Challenger blog for more Diagnostic Challenge blogs and other free clinical content from Med-Challenger.

About the Author:

Paul Griner MD, MACP graduated from the University of Rochester School of Medicine and completed his residency at the Massachusetts General Hospital, Boston, MA. He has served the University of Rochester School of Medicine as Chief Resident in Medicine and as Professor, Department of Medicine. He has served as a Senior Lecturer at Harvard Medical School and consultant at the Massachusetts General Hospital where he introduced a mentoring program for the faculty of General Internal Medicine. Dr. Griner is board certified in internal medicine.