Skin and Mucosal Hemorrhage (Purpura and Petechiae): Or something else? Differential Diagnosis

Congenital malformations, deformities, and chromosomal abnormalities (Q00-Q99).

Blood, blood-forming organs – immune system (D50-D90).

  • Aplastic anemia – form of anemia (anemia) characterized by pancytopenia (reduction of all cell series in the blood; stem cell disease) and concomitant hypoplasia (functional impairment) of the bone marrow.
  • Coagulation disorders, unspecified (e.g., factor IX deficiency, Willebrand-Jürgens syndrome).
  • Hemophilia (hemophilia).
  • Cryoglobulinemia – chronic recurrent immune complex vasculitis (immune disease of the vessels) characterized by the detection of abnormal cold precipitating serum proteins (cold antibodies).
  • Purpura; here, forms of purpura:
    • Autoerythrocytic purpura (Gardner-Diamond syndrome) – painful skin bleeding that occurs predominantly in young women.
    • Posttransfusional purpura – skin bleeding that occurs after blood transfusion; caused by platelet antibodies.
    • Psychogenic purpura
    • Purpura anaphylactoides (P. allergica, P. rheumatica) – toxic-allergic skin hemorrhages that occur after infections or but by drugs as well as food.
    • Purpura anularis teleangiectodes (Majocchi syndrome) – form of purpura associated with arterial hypertension (high blood pressure), atherosclerosis (arteriosclerosis, arteriosclerosis) and telangiectasia (vascular veins).
    • Purpura cerebri – hemorrhage in the brain, which is due to local capillary damage.
    • Purpura cryoglobulinaemia – form of skin hemorrhage caused by cryoglobulinemia.
    • Purpura factitia – skin hemorrhages caused by manipulation of the skin.
    • Purpura fulminans – severe general symptoms; patchy to extensive skin hemorrhages (sugillations) that rapidly progress to hemorrhagic skin necrosis (death of the skin); occurrence in a symmetrical arrangement on the face, extremities and trunk.
    • Purpura fulminans Henoch – highly acute onset and severe form of purpura abdominalis as well as purpura anaphylactoides.
    • Purpura haemorrhagica (idiopathic thrombocytopenia Werlhof, idiopathic thrombocytopenic purpura, ITP; Werlhof’s disease) – disorder of platelet function.
    • Purpura haemorrhagica nodularis (Fabry syndrome) – genetic storage disease that, in addition to skin hemorrhages, leads, among other things, to hypertension (high blood pressure) and renal insufficiency (kidney weakness; kidney failure).
    • Purpura hyperglobulinaemica (Waldenström’s disease) – skin bleeding that occurs in the context of paraproteinemias (increased occurrence of proteins from uncontrolled proliferating cells).
    • Purpura jaune dócre (purpura orthostatica; stasis bleeding).
    • Purpura necroticans Sheldon – form of purpura fulminans occurring in infants and young children.
    • Purpura pigmentosa progressiva (purpura chronica progressiva, Schamberg’s disease) – form of skin hemorrhage likely caused by drugs or food
    • Purpura pulicosa – allergic reaction to flea bites with bleeding and wheals.
    • Purpura senilis (senile purpura; (age-sugillations without disease value) – form of purpura that occurs mostly in older people with actinic (light) damaged skin.
    • Purpura thrombasthenica (Glanzmann-Naegeli thrombasthenia) – genetic blood clotting disorder caused by a structural defect in the membrane of platelets (blood platelets).
    • Thrombotic thrombocytopenic purpura (TTP; synonym: Moschcowitz syndrome) – acute onset of purpura with fever, renal insufficiency (kidney weakness; kidney failure), anemia (anemia), and transient neurological and mental disorders; occurrence largely sporadic, in the familial form autosomal dominant.
  • Thrombocytopenia – reduction in the number of platelets.
  • Consumption coagulopathy – consumption of clotting factors; occurs mainly in life-threatening diseases such as sepsis (blood poisoning).

Endocrine, nutritional and metabolic diseases (E00-E90).

  • Cushing’s disease – group of disorders leading to hypercortisolism (hypercortisolism; excess of cortisol).
  • Vitamin C deficiency
  • Vitamin K deficiency

Cardiovascular system (I00-I99)

Infectious and parasitic diseases (A00-B99).

  • Cytomegaly
  • Dengue fever – infectious disease that occurs mainly in tropical and subtropical regions.
  • Rock mountain fever (tick-borne fever) – acute infectious disease caused by bacteria of the genus Rickettsia.
  • HIV – disease caused by the human immunodeficiency virus (HI virus).
  • Leptospirosis (Weil’s disease) – infectious disease caused by leptospires and usually transmitted by animals or skin/mucous membrane contact.
  • Meningococcal sepsis – form of blood poisoning caused by the bacterium Neisseria meningitidis.
  • Syphilis (lues, venereal disease).
  • Trichinellosis (trichinae)
  • Viral hemorrhagic fever

Liver, gallbladder and bile ducts – Pancreas (pancreas) (K70-K77; K80-K87).

  • Liver disease, unspecified
  • Alcoholic cirrhosis – irreversible damage to the liver leading to gradual connective tissue remodeling of the liver with impairment of liver function.

Musculoskeletal system and connective tissue (M00-M99).

  • Connective tissue disease, unspecified.

Neoplasms – tumor diseases (C00-D48).

  • Chronic lymphocytic leukemia (CLL) – malignant neoplasm of the hematopoietic system (hemoblastosis).
  • Paraproteinemia (increased occurrence of proteins from uncontrolled proliferating cells) – e.g. cryoglobulinemia → purpura cryoglobulinaemia.
  • Leukemias (blood cancer)
  • Malignant lymphoma (malignant neoplasm originating in the lymphatic system), predominantly associated with Hodgkin’s disease (malignant neoplasm (malignant neoplasm) of the lymphatic system with possible involvement of other organs).

Pregnancy, childbirth and puerperium (O00-O99).

  • Pregnancy – may lead to purpura via increased intravascular pressure (pressure within the vessels).

Genitourinary system (kidneys, urinary tract – sex organs) (N00-N99).

Injuries, poisoning, and other sequelae of external causes (S00-T98).

  • Injuries, unspecified

Other causes

  • Increased intravascular pressure (pressure in the vascular system); may be due to coughing, vomiting.

Medication

  • Anticoagulants (anticoagulant medications) such as acetylsalicylic acid (ASA), phenprocoumon (coumarin derivative), or warfarin (from the group of 4-hydroxycoumarins, which in turn are vitamin K antagonists and belong to the group of anticoagulants)
  • Corticosteroids
  • Cytostaticsdrugs used to treat cancer.