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2098 Part XII: Hemostasis and Thrombosis Chapter 122: The Vascular Purpuras 2099

TABLE 122–1. Palpable Noninflammatory Purpuric Lesions
A. Dysproteinemias
1. Cryoglobulinemia (see Figs. 122–3 and 122–4)
2. Waldenström hyperglobulinemic purpura (see Fig. 122–5)
3. Light-chain vasculopathy
4. Cryofibrinogenemia
B. Thrombotic
1. Heparin necrosis
2. Warfarin necrosis (see Fig. 122–6)
3. Protein C and protein S deficiencies
4. Paroxysmal nocturnal hemoglobinuria
5. Antiphospholipid syndrome (see Fig. 122–8)
A B 6. Livedoid vasculitis
C. Embolic
1. Cholesterol emboli (see Fig. 122–9)
2. Cutaneous calciphylaxis
3. Emboli from intracardiac thrombi
D. Arthropod bites

TABLE 122–2. Palpable and Nonpalpable Inflammatory
Purpuric Lesions
A. Pyoderma gangrenosum (see Fig. 122–7)
B. Sweet syndrome (see Fig. 122–10)
C. Behçet disease
D. Serum sickness (Fig. 122–11)
E. Henoch-Schönlein purpura (see Fig. 122–12)
A B F. Infections
Figure 122–1. A. Spider telangiectasia. B. Blanching of spider telang- G. Erythema multiforme (see Fig. 122–20)
iectasia. Note that spider telangiectasia blanches with diascopy. H. Cutaneous polyarteritis nodosum (see Fig. 122–21)
I. Paraneoplastic vasculitis
J. Drug-induced vasculitis
K. Antineutrophilic cytoplasmic antibody–associated vasculitides
1. Wegener granulomatosis (see Fig. 122–23)
2. Churg-Strauss
Is purpuric
lesion palpable?
TABLE 122–3. Nonpalpable, Noninflammatory, Round
Purpuric Lesions
A. Increased transmural pressure gradient and trauma
YES NO B. Drug reactions
C. Coagulation disorders
D. Decreased vessel integrity without trauma
Is there If YES, see Is there 1. Senile purpura
evidence of Table 122–2 evidence of 2. Excess glucocorticoid (Cushing syndrome, glucocorticoid
inflammation? inflammation?
treatment)
3. Scurvy—vitamin C deficiency (see Fig. 122–25)
If NO, consider If retiform, If NO, is 4. Systemic amyloidosis
vascular consider vascular lesion retiform ∗ 5. Connective tissue disorders (Ehlers-Danlos syndrome,
occlusion; see occlusion; see or round? pseudoxanthoma elasticum)
Table 122–1 Table 122–1
6. Mitochondrial encephalomyopathy with lactic acidosis and
stroke-like syndrome (MELAS)
If round, E. Waldenström hypergammaglobulinemic purpura (see
* Retiform refers to branching, stellate pattern see Table 122–3 Table 122–1 and Fig. 122–5)
F. Rendu-Osler-Weber disease (see Fig. 122–26)
Figure 122–2. Bedside approach to purpuric lesion diagnosis.

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