Post-vomiting purpura

We present two cases thatpresented with purpuric lesions over the face,-which developed immediately after a bout of forceful vomiting.

The first patient was a 7-year-old male child who presented with red lesions over the face after a single episode of vomiting [Figure 1]. On examination the lesions were purpuric, but not palpable (except for a few lesions where the petechia seemed to be superimposed over pre-existing milia). The child presented to us on the same day of the vomiting episode. The father mentioned that the vomiting was forceful. The child had been seen by the pediatrician on the same day. The pediatrician had considered a diagnosis of gastritis.

Figure 1.

Petechial lesions on the face after vomiting

The second patient was a 21-year-old male patient who also presented to us with purpuric lesions after a bout of forceful vomiting. The patient presented to us three days after the episode of vomiting and by then the lesions had subsided considerably [Figure 2]. The patient had not taken a medical consultation for the vomiting itself, but had self-diagnosed it as gastritis.

Figure 2.

Resolving petechial lesions on the face

Both patients were otherwise healthy and there was no previous history of any similar lesions in the past in the patient or his family. There were no skin lesions elsewhere, including the oral and conjunctival mucosa There was no history of any significant sun-exposure, trauma, fever, or any associated drug intake. In both the patients all laboratory investigations including bleeding/clotting parameters, and work-up for vascultis were within normal limits and the lesions resolved without any treatment within a week. Vitamin C levels were not measured; however, both the patient did not have any other skin or systemic features suggestive of vitamin C deficiency.

Dermoscopy in both cases revealed nonblanching, structureless purple areas, which is consistent with purpura [Figure 3]. Skin biopsy was not done in either case.

Figure 3.

Dermoscopy showing nonblanching, irregular, and structureless purple areas (10×, polarized light)

We present these two cases to highlight the rare but definite entity called postvomiting purpura/petechiae. Petechial lesions after straining during activities such ascrying, coughing, vomiting, weightlifting, and delivery can occur in otherwise normal individuals. The lesions are self-resolving and require no specific intervention other than patient counseling.[1,2] Although a good hand lens and diascopy is sufficient to make a clear clinical diagnosis, dermoscopy may be a useful diagnostic tool in this condition.

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Conflicts of interest

There are no conflicts of interest.