Please login or create an account. If you do not have access to this content, you will be shown a 30 second preview and licensing options.
- Presentation
Inpatient Dermatology: From Horses to Zebras - Lessons Learned at an Academic Hospital
Description
In this presentation by Sergey Rachman of Northwell Health, he discusses inpatient dermatology, particularly focusing on retiform purpura, a complex dermatological condition characterized by unique morphological features. Rachman emphasizes the importance of recognizing retiform purpura, distinguishing it from other forms like palpable purpura through a systematic approach in diagnosis, which includes patient history, appropriate biopsy techniques, and laboratory workups. He categorizes differential diagnoses into thromboembolic, immune-mediated, infectious, and depositional causes, highlighting critical initial lab tests and the necessity for targeted biopsies. Rachman presents three patient cases that illustrate various complications arising from retiform purpura. The first case involves a young woman with protein S deficiency and multi-organ failure, leading to an anti-phospholipid syndrome diagnosis, treated successfully with anticoagulation. The second case features a female patient who experienced skin necrosis following an elective surgery and received a diagnosis of anoxaparin-induced skin necrosis. The final case concerns a patient suffering from cardiogenic shock who ultimately was diagnosed with non-uremic calciphylaxis but sadly did not respond well to treatment. Rachman concludes by highlighting the nuanced relationship between vasculitis and vasculopathy, and the importance of careful management practices surrounding these conditions in acute hospital settings.
View moreConclusions
- Retiform purpura can arise from various causes, including thromboembolic and vasculitic disorders.
- A thorough differential diagnosis is essential when assessing retiform purpura to avoid missing life-threatening conditions.
- Biopsies play a critical role in diagnosing retiform purpura and should be performed on non-necrotic lesions for accuracy.
- Initial blood workup should include a complete blood count, metabolic panel, and urinalysis to assess the patient's overall health.
- Urgent laboratory testing for hypercoagulable states and infectious causes may be necessary based on the clinical context.
- Treatment should be tailored to the underlying cause, whether it's infection, immunosuppression for vasculitis, or anticoagulation for thromboembolic events.
- Patients with a history of protein S deficiency may be at greater risk for thromboembolic complications, requiring careful monitoring and management.
- Individuals presenting with skin changes post-enoxaparin administration should be evaluated for possible enoxaparin-induced skin necrosis.
- Non-uremic calciphylaxis may not be related to chronic kidney disease but should be treated with careful management of metabolic acidosis and appropriate anticoagulation.
- In cases of catastrophic antiphospholipid syndrome, timely recognition and treatment can stabilize the patient's condition and prevent further complications.
- Georgesen C, Fox LP, Harp J. Retiform purpura: A diagnostic approach. J Am Acad Dermatol. 2020 Apr;82(4):783-796.
- Asherson RA, Cervera R, de Groot PG, Erkan D, Boffa MC, Piette JC, Khamashta MA, Shoenfeld Y; Catastrophic Antiphospholipid Syndrome Registry Project Group. Catastrophic antiphospholipid syndrome: international consensus statement on classification criteria and treatment guidelines. Lupus.
- Issa AA, Simman R. Lovenox Induced Tissue Necrosis, a Case Report and Literature Review. J Am Coll Clin Wound Spec. 2015;5(3):66-68.
- Coelho J, Izadi D, Gujral S. Enoxaparin-Induced Skin Necrosis. Eplasty. 2016 Sep 21;16:ic40 ..
- Altman K, Shinohara M. Demographics, Comorbid Conditions, and Outcomes of Patients With Nonuremic Calciphylaxis. JAMA Dermatol. 2019 Feb 1;155(2):251-252. doi: 10.1001/jamadermatol.2018.4937.