Pankti Mehta Profile picture
Clinical fellow @UHN @UofT | Immunology & Rheumatology| DSMC member @rheumjnl @IJRheum @IndianRheum | Alumnus @SGPGI (rheum) @KEMhospital (MBBS, Int Med)

Jun 3, 2023, 6 tweets

Hey #MedTwitter !

1. What does the image show?
2. Possible etiologies?

#RheumTwitter

It's a purpuric rash. The two most important DDs are:

🔹Small vessel vasculitis (lupus, ANCA, cryoglobulinemia etc) ♨️

🔹Infective endocarditis (janeway lesions) ❣️

Bleeding disorders often affect areas where the skin is soft and loose rather than the soles

Other causes of palmoplantar rash

1️⃣Infections- maculopapular, blanching

🔹Viral eg parvovirus, coxsackie, measles
🔹Bacterial- menigococcimia (purpuric, non blanching), syphilis (2°)
🔹Rickettsia- RMSF

#MedTwitter #MedEd

2️⃣ Erythema Multiforme

Macular targetoid lesions- immune phenomenon secondary to infections (herpes simplex, mycoplasma) or drugs

3️⃣ Psoriasiform

Scaly erythematous plaques

🔹 Palmoplantar psoriasis
🔹Keratoderma blenorrhagicum

Both are clinically indistinguishable

🔹Other cause of a nodular scaly rash is arsenic keratosis

4️⃣ Palmar Erythema

Kawasaki's disease, CLD, pregnancy etc

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