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Home arrow-right-small-blue Quizzes arrow-right-small-blue Leg rashes and unwell – 10 cases

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Quiz
Leg rashes and unwell – 10 cases

Each of these patients is unwell and presented with a rash on their legs.

For each of the ten cases, study the image(s) and then answer the questions. You can click on the image to view a larger version if required.

Each case should take approximately 2 minutes to complete. There is a list of suggested further reading material at the end of the quiz.

Case 5

The patient was a 20-year-old male, who presented with abdominal pain, painful joints and a rash extending from his buttocks to his feet, two weeks after having a sore throat. The rash consisted of a symmetrical eruption of numerous purpuric papules and plaques.

Henoch Schonlein purpura

The underlying reason for the vasculitis was streptococcal infection, resulting in Henoch-Schönlein purpura (HSP). As is typical for HSP, the patient had a small malaena. Concern about renal function led to microscopic examination of urine, which was unremarkable.

He was treated with oral penicillin V for 10 days and provided with supportive stockings. Crops of new lesions continued to occur over the next several weeks, before resolving spontaneously.

The diagnosis of HSP is usually clinical: palpable purpura and abdominal pain arising in a child or young adult. It is a small vessel immune complex-mediated vasculitis associated with deposition of IgA.

Treatment is directed against the underlying cause when identified. It is not usually necessary to treat the skin disease with oral steroids or other immunosuppressive treatment but management of renal disease may require these.

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