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Unexplained rash/petechiae on leg
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Unexplained rash/petechiae on leg

I am a 29 year old, Caucasian male.  A few months ago, I saw a Dermatologist and tested positive on a nasal swab for MRSA.  He told me that it shouldn't be a big deal and it is just part of my normal flora since I was asymptomatic.  

This past Saturday, I developed a rash on my left shin about the size of my palm.  It does not itch and has not opened up or wept, but is painful to the touch.  It has worsened since it first appeared and is now dark purple/red and spread down to my ankle.  I went to my Family Medicine practitioner first thing Monday morning and he immediately diagnosed it as MRSA, without any cultures.  He took a swab, however, of the outside of the rash and sent it off to be grown.  He prescribed Clindamycin 300mg qid and told me to keep it elevated.  The preliminary results indicate that I definitely have staph, but it might not be MRSA.  He now doesn't seem quite sure what it is and wants to biopsy it, since it still hasn't developed pustules.  Some other symptoms, which I have been experiencing lately are unexplained weight loss to the tune of 35 pounds in the last month.  I also have joint/bone pain and reoccurring flu-like symptoms.  I figure that it is just my body fighting off an infection, but now I'm not sure if it is an infection it is fighting.  Is it possible that the swabs are just picking up the normal Staphylococcus aureus that I've tested positive for in the past?  Would a biopsy be the next step to figuring out what this is on my leg?

The only pictures I have found online that match what is on my leg are for leukemia.  Is it possible that my doctor is doing to biopsy to check for this?  He didn't seem like was wanted to share his ideas at this moment.  I haven't had recent blood work since this started, but I charted my blood work over the last two years and I have consistently had low MPV, low neutrophils, and high lymphocytes.  Could this be of any use in explaining what is causing my current issue.

Thank you for your time and thoughts.

I also posted this in Dermatology in case it isn't leukemia.
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1081992_tn?1389907237
It looks possible then that you are correct in thinking that the problem is not MRSA, but the MRSA is coincidentally there - where it can normally be without causing any problem.

If you have petechiae, then you might expect to see also bleeding from the gums, or else easy bruising anywhere.

As far as weight loss, when it is from advanced cancer (cachexia) then loss will occur no matter how much a person eats - or else it would simply be a matter of hooking up to an IV to provide adequate nutrition and no one would waste away.

As far as the unintentional rapid weight loss, there is a list of things that can cause that - but it would be reasonable to assume at this point that the same underlying condition is causing everything. Bananas and greens wouldn't do it.

If the weight loss is continuing I'd definitely exercise in order to preserve muscle mass as much as possible.

Also, fat soluble substances such as some hormones and even toxins are stored in fat cells. When fat is lost, they get released and can cause effects.



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1081992_tn?1389907237
Hi, I'd think that a simple CBC would tell you a lot. If your platelet count is low, then that could be because production is crowded out in the  marrow by malignant cells. However, a virus can kill off platelets - so can autoimmunity (e.g., ITP). Lymphocytes can be expected to be high due to a virus. A virus can kill neutrophils.

I don't know if a MRSA infection on the shin is rough or not, but petechiae are under the surface so the surface would be smooth. Kind of like blotchiness. Do you match the picture on wikipedia for petechia?

Platelet number can be normal but function is impaired, so you can still get petechiae that way.

A CBC could reveal very high leukocytes, as in diagnosing leukemia.

You wouldn't biopsy a petechia to find a blood malignancy. I suspect he wants to identify an infectious organism - especially since he hasn't ordered a CBC.

Ir it could all be some rare cause, or an atypical case of something not rare.

Still, your weight loss seems extreme. Did you eat less, or eat the same as usual but still lose the weight?



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Avatar_m_tn
The blotches on my shin are smooth and under my skin, which my physician has said is abnormal for mrsa.  I did get the final report back and it was positive for MRSA and coagulase- negative staphylococcus aureus.  I'be switched to another antibiotic since it was resistant to what I was taking.  I'll try to push for a CBC to see what's going on.  As for the weight loss, the only thing I've changed is that I have been eating more bananas and a small bowl of salad greens with lunch.  Other than that, not much has changed about my lifestyle.  Is that enough to trigger rapid weight loss?
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1081992_tn?1389907237
It looks possible then that you are correct in thinking that the problem is not MRSA, but the MRSA is coincidentally there - where it can normally be without causing any problem.

If you have petechiae, then you might expect to see also bleeding from the gums, or else easy bruising anywhere.

As far as weight loss, when it is from advanced cancer (cachexia) then loss will occur no matter how much a person eats - or else it would simply be a matter of hooking up to an IV to provide adequate nutrition and no one would waste away.

As far as the unintentional rapid weight loss, there is a list of things that can cause that - but it would be reasonable to assume at this point that the same underlying condition is causing everything. Bananas and greens wouldn't do it.

If the weight loss is continuing I'd definitely exercise in order to preserve muscle mass as much as possible.

Also, fat soluble substances such as some hormones and even toxins are stored in fat cells. When fat is lost, they get released and can cause effects.



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