Petechiae / Rash

[stiz]

Recently I noticed a red rash on my arm. Slightly raised. It did not itch. At the same time I had petchiae appear all over my body.

I had the petechiae appear two times before, maybe a year apart.

I know that the petechiae appeared in January 2005 (almost 2 years ago). They were more extensive this time. I think in all cases they appeared within a few days of air travel if that's relevant. Also, I just got over a bad cold that lasted about 3 weeks.

The petechiea and rash are almost gone after 3 days...

I had blood tests done this time while the petchiae and rash were still present. The physician said the tests looked normal and that I probably had an allergic reaction to something. He gave me prednisone.

However, some of the results were out of range...

Absolute Lymph Count 0.8K/cmm  ref. range (1.5-4.0)
Neutrophil 75.4% ref. range (40-74)
Lymph 15.3% ref. range (19.6-52.7)

also from the urinalysis the following were slightly high:
total bilirubin 1.3 mg/dl
ALT 44 iu/l

My question is that while the rash is indicative of an allergic
reaction, what about the petechiae...and what about the 2 previous times i got the petechiae without any rash.

Also what about the results of the CBC that are outside of
normal ranges.

Could this be indicative of some immune system problem???

What should I do? More tests? Any thoughts? Suggestions?

Thanks very much.

Otherwise I feel very healthy. I'm in good shape, I'm a 38
year old male. 6'3" tall. ~200 lbs.

[Kevin Pho, MD]

To answer your questions:
1) It is difficult to say without evaluation.  A skin biopsy can be considered for a more definitive diagnosis.

2) The lymphocyte count is low.  This can be repeated to ensure this isn't laboratory error.  If it continues, a referral to a hematologist can be considered.  Further evaluation can be considered with evaluating the blood smear under a microscope or a bone marrow biopsy.

3) Difficult to say.  Evaluation with the aforementioned tests can be considered.

4) A referral to a dermatologist and/or hematologist can be considered as further diagnostic options.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
kevinmd_

[Kalio1]

Petechiae often is a sign of an underlying immune system issue
and can be a symptom of a liver disorder and/or a blood disorder. I'd have a full hepatic panel done especially since your bili is out of whack. Unless you already know, find out what your AST/ALT (liver enzymes) readings are, find out what your platelet count is and keep looking for an answer. I'd abstain from alcohol until you know what is going on in case it is a liver issue.
Have you been screened/tested for hepatitis B and C? Have you been vaccinated against Hep B and A? If not, I would do that soon. Ask for the test to be added to your bloodwork. Most of the people that have it contracted it through IV drug use HOWEVER nearly 40% of people with this hard to diagnose virus do NOT have this type of history so unfortunately there are lots of people who have it ( millions) and they do not know they have it. Doctors do not test/screen for this virus routinely.

I had Petechiae and was diagnosed as having a "drug allergy" and at one point was told it could be "viral" but the connection to WHAT virus was never made. I got the impression they meant a flu virus or something, I didn't realize I had a virus that was not transient! Eventually after I became quite ill and it became clear I had an underlying immune system issue, finally someone tested for Hepatitis C and low and behold, I had it. Hepatitis C is known as a liver problem but in fact it IS an immune system/blood disease that affects your liver but it is not limited to the liver in ways it can cause harm. Petechiae was my FIRST sign, the fact you have had it happen a few times before makes me wonder, please get tested to either discover if you have it or rule it out.
It is a very sneaky disease which is why it is known as a "silent killer" disease and people are often misdiagnosed.

best of luck