Non-palpable rash without any history of travel. Which of the following is the most likely diagnosis?
- Drug hypersensitivity reaction
- Rocky mountain spotted fever
- Nutritional deficiency
- Vasculitis
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RULING OUT - Which of the following is the most likely diagnosis?
A. drug hypersensitivity reaction (typically without purpuric lesions)
B. rocky mountain spotted fever (no history of travel or tick bite)
C. nutritional deficiency
D. Vasculitis (purpura would not be perifollicular and would be palpable)
Scurvy results from insufficient vitamin C intake (i.e. alcoholism), increased vitamin requirement (i.e.certain medications), and increased loss (i.e. dialysis)
Vitamin C is required for normal collagen structure and its absence leads to skin and vessel fragility
Characteristic exam findings include:
• perfollicular purpura
• large ecchymoses on the lower legs
• intramuscular and periosteal hemmorrhage
• keratotic plugging of hair follicles
• hemorrhagic gingivitis (when patient has poor oral hygeine)