[bollweevil]

small punctate red macules on a shin, no itching, burning, drainage, no known etiology

We are calling in Infectious Disease (not sure why), Allergist, Dermatologist, Cardiologist, not sure who else; This was discovered a couple of days ago during a bath. Patient was not aware she had them and denies any problems with them, we are all curious as to what they are.

Have you ever had a patient with something like this?

History includes DM, HTN, s/p CVA; some evidence of poor circulation in legs, that is, longstanding brown deposits in skin.

Thanks.

[bollweevil]

I think they indicate liver disease or some type of circulatory trouble. Pt is asymptomatic, these are newly acquired, thus ruling out, I believe hemangioma and a-v malformations.

[StrwbryblndRN]

Interesting. I have no idea but keep us posted as to what it may be.

[chadash]

Could this be vascular? If her circulation to her extremities is compromised, could the capillaries be doing some sort of compensatory thingemagig?

[bollweevil]

Originally Posted by chadash

Could this be vascular? If her circulation to her extremities is compromised, could the capillaries be doing some sort of compensatory thingemagig?

That's what I'm thinking but not quite sure.

[grandee3]

I may be out in left field with this one, but I had a pt last week with HHT. Some type of hemorrhage under the skin.

[nightmare]

could be Necrobiosis lipoidica ,often seen in diabetics.

[chadash]

Originally Posted by grandee3

I may be out in left field with this one, but I had a pt last week with HHT. Some type of hemorrhage under the skin.

You mean like petechia? Could it be platelets are too low?
Sounds different that petechia....

[TiredMD]

Originally Posted by bollweevil

We are calling in Infectious Disease (not sure why), Allergist, Dermatologist, Cardiologist, not sure who else; This was discovered a couple of days ago during a bath. Patient was not aware she had them and denies any problems with them, we are all curious as to what they are.

That's a lot of money being spent on a finding that doesn't bother the patient.

Was this in a primary care clinic? Do a punch biopsy (or if not comfortable with that, a skin scraping), send it to path and see what they say. Boom, you just saved the patient's insurance $3000.

[blueheaven]

Vasculitis syndrome of some sort?