Image IQ: Petechia and Palpable Purpura on the Palms of Hands, Fingers, and Toes

April 1, 2020

A 40-year-old woman went to the doctor after petechia and palpable purpura appeared on the palms of her hands, fingers, and toes. She appeared chronically ill and had significant weight loss. Her doctor also noted the presences of Osler nodes. She did not have any recent injuries or skin punctures and reported she had been in good health until the last few weeks.  Based on these clues, how would you diagnose this patient?

A 40-year-old woman went to the doctor after petechia and palpable purpura appeared on the palms of her hands, fingers, and toes. She appeared chronically ill and had significant weight loss. Her doctor also noted the presences of Osler nodes. She did not have any recent injuries or skin punctures and reported she had been in good health until the last few weeks.  Based on these clues, how would you diagnose this patient?

A. Leukocytoclastic vasculitis
B. Subacute bacterial endocarditis
C. Candida sepsis
D. Thrombotic thrombocytopenic pupura (TTP)

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