Ponce de Souza Emi, Usatine Richard P
University of Texas Health Sciences Center at San Antonio, Department of Family and Community Medicine, San Antonio, TX 78229-3900 USA.
J Fam Pract. 2005 Jun;54(6):520-3.
A 21-year-old woman came to the clinic, frightened by a painful purpuric rash on her lower extremities. The lesions appeared suddenly 3 days before, with no prior similar episodes. The pain, and some swelling that happened when she stood, had finally driven her to take some time off from her job and seek medical advice. She was diagnosed with a case of pharyngitis earlier that week; due to multiple drug allergies, she was prescribed a course of clindamycin. She had not experienced any nausea or vomiting, fever, abdominal cramping, or gross hematuria. On examination, the patient was friendly and good-humored, although she was concerned about her rash and visibly uncomfortable. She was walking with the aid of a borrowed cane, but her lesions were no longer tender to palpation. The rash consisted mainly of purpuric papules almost entirely limited to her legs, although some isolated lesions were on her back as well. The papules were concentrated around her distal lower extremities, with a clear line of lesions encircling her calves bilaterally where her knee-high socks had applied pressure for the last 2 days. Mild edema was noted, but the rest of her physical exam was normal. By dipstick, the patient had blood in her urine but no protein. What is the diagnosis? What is the treatment for this condition?
一名21岁女性因下肢疼痛性紫癜皮疹前来诊所。皮疹于3天前突然出现，之前无类似发作史。疼痛以及站立时出现的一些肿胀最终促使她请假并寻求医疗建议。本周早些时候她被诊断为咽炎；由于多种药物过敏，她被开了一个疗程的克林霉素。她没有经历任何恶心、呕吐、发热、腹部绞痛或肉眼血尿。检查时，患者友善且心情不错，尽管她担心自己的皮疹且明显感到不适。她借助一根借来的拐杖行走，但皮疹触诊时已不再疼痛。皮疹主要由紫癜性丘疹组成，几乎完全局限于她的腿部，尽管背部也有一些孤立的皮疹。丘疹集中在她下肢远端，在她膝盖以上的袜子施加压力的双侧小腿周围有一条清晰的皮疹线。发现有轻度水肿，但她其余的体格检查正常。通过试纸检测，患者尿液中有血但无蛋白质。诊断是什么？这种情况的治疗方法是什么？
