adj.

点状出血の

関: dot hemorrhage、petechia、petechiae、petechial hemorrhage

WordNet

a minute red or purple spot on the surface of the skin as the result of tiny hemorrhages of blood vessels in the skin (as in typhoid fever)

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/09/20 23:17:27」(JST)

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A petechia, plural petechiae, is a small (1–2 mm) red or purple spot on the skin, caused by a minor bleed (from broken capillary blood vessels).^[1]

Petechia refers to one of the three descriptive types of bleeding into the skin differentiated by size, the other two being purpura and ecchymosis. Petechiae are by definition less than 3 mm.

The term is almost always used in the plural, since a single lesion is seldom noticed or significant.

Causes

The most common cause of petechiae is through physical trauma such as a hard bout of coughing, holding breath, vomiting or crying, which can result in facial petechiae, especially around the eyes. Petechiae in this instance are harmless and usually disappear within a few days. Petechiae may be a sign of thrombocytopenia (low platelet counts) when platelet function is inhibited (e.g., as a side effect of medications or during certain infections), or in clotting factor deficiencies.^[1] They may also occur when excessive pressure is applied to tissue (e.g., when a tourniquet is applied to an extremity or with excessive coughing or vomiting).

If unsure, petechiae should always be quickly investigated. They can be interpreted as vasculitis, an inflammation of the blood vessels, which requires immediate treatment to prevent permanent damage. Some malignancies can also cause petechiae to appear. Petechiae should be investigated by a doctor to rule out the more dangerous conditions.

The significance of petechiae in children depends on the clinical context in which they arise. Petechiae in children can occur with viral infections. In this instance, they do not necessarily signify a serious illness. However, they are a hallmark signal of some potentially serious illnesses, such as meningococcemia, leukemia, and certain causes of thrombocytopenia, of which meningococcemia can cause death within 48 hours of infection. Therefore, their presence should not be ignored.

Petechiae (in the face) may also be present in cases of self asphyxiation.

Categories of causes

Infections

Babesiosis
Bolivian hemorrhagic fever
Boutonneuse fever
Chikungunya
Cerebral malaria
Congenital syphilis
Crimean–Congo hemorrhagic fever
Cytomegalovirus
Dengue fever
Dukes' disease
Ebola
Endocarditis
Influenza A virus subtype H1N1
Hantavirus
Infectious mononucleosis
Marburg virus
Neisseria meningitidis
Rocky Mountain spotted fever
Scarlet fever
Typhus ^[2]

Non-infectious conditions

Hypocalcemia
Idiopathic thrombocytopenic purpura
Leukemia
Celiac Disease
Aplastic anaemia
Scurvy
Lupus
Childhood protein-energy malnutrition such as Kwashiorkor or Marasmus
Erythroblastosis fetalis
Henoch-Schönlein purpura
Kawasaki disease
Schamberg's disease
Ehlers–Danlos syndrome
Sjogren's Syndrome

Trauma

Gua Sha, a Chinese treatment that scrapes the skin
High-G training
Hickey (injury)
Asphyxiation (discussed below)

Causes of particular types

Palatal petechiae.

Petechiae on the soft palate are mainly associated with streptococcal pharyngitis,^[3] and as such it is an uncommon but highly specific finding.^[4]

Facial petechiae, especially around the eyes, indicate physical trauma such as by hard bouts of coughing, vomiting or crying.

Forensics

Petechiae on the face and conjunctiva (eyes) can be a sign of a death by asphyxiation, particularly when involving reduced venous return from the head (such as in strangulation). Petechiae are thought to result from an increase of pressure in the veins of the head and hypoxic damage to endothelia of blood vessels.^[5]

Petechiae can be used by police investigators in determining if strangulation has been part of an attack. The documentation of the presence of petechiae on a victim can help police investigators prove the case.^[6] Petechiae resulting from strangulation can be relatively tiny and light in color to very bright and pronounced. Petechiae may be seen on the face, in the whites of the eyes or on the inside of the eyelids.

References

^ ^a ^b Kumar, Vinay; Abbas, Abul K.; Fausto, Nelson; & Mitchell, Richard N. (2007). Robbins Basic Pathology (8th ed.). Saunders Elsevier. p. 86 ISBN 978-1-4160-2973-1
^ Grayson MD, Charlotte (2006-09-26). "Typhus". MedlinePlus Medical Encyclopedia. National Institutes of Health. Retrieved 2007-11-05.
^ Fact Sheet: Tonsillitis from American Academy of Otolaryngology. "Updated 1/11". Retrieved November 2011
^ Brook I, Dohar JE (December 2006). "Management of group A beta-hemolytic streptococcal pharyngotonsillitis in children". J Fam Pract 55 (12): S1–11; quiz S12. PMID 17137534.
^ Ely, Susan F.; Charles S. Hirsch (2000). "Ashpyxial deaths and petechiae: a review" (PDF). Journal of Forensic Science 45 (6): 1274–1277. Retrieved 2007-09-22.
^ "Investigating Domestic Violence Strangulation". BlueSheepdog.com. Retrieved 12 May 2011.

UpToDate Contents

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1. 血管炎の皮膚病変を有する成人の評価 evaluation of adults with cutaneous lesions of vasculitis
2. 小児における紫斑の評価 evaluation of purpura in children
3. 出血性素因を有する成人患者へのアプローチ approach to the adult patient with a bleeding diathesis
4. ヘノッホ・シェーンライン紫斑病（IgA血管炎）：臨床症状および診断 henoch schonlein purpura immunoglobulin a vasculitis clinical manifestations and diagnosis
5. 皮膚小血管性血管炎の概要 overview of cutaneous small vessel vasculitis

English Journal

Nontraumatic Retroperitoneal Hematoma After Warfarin Administration: Fatal Case Report and Review of the Literature.

Hosseini M1, Hosseinzadeh A, Raufian K, Hedjazi A.
The American journal of forensic medicine and pathology.Am J Forensic Med Pathol.2015 Dec;36(4):245-8. doi: 10.1097/PAF.0000000000000190.
Spontaneous retroperitoneal hematoma after warfarin therapy is an extremely rare event. Here, we report a 25-year-old man who was brought in to the emergency service with confusion. On arrival, the patient had hypotension, tachycardia, tachypnea, low-grade fever, and Glasgow Coma Scale score of 12.
PMID 26280884

Hirame rhabdovirus (HIRRV) as the cause of a natural disease outbreak in cultured black seabream (Acanthopagrus schlegeli) in Korea.

Kim WS1, Oh MJ2.
Archives of virology.Arch Virol.2015 Dec;160(12):3063-6. doi: 10.1007/s00705-015-2573-1. Epub 2015 Aug 28.
In 2015, a high mortality rate of about 40 % was observed in black seabream (Acanthopagrus schlegeli) on a farm on the southern coast of Korea. Most of the diseased fish showed a hemorrhage of the mouth, pale liver, petechial hemorrhaging in the internal fat, and an enlarged spleen. Other than Alel
PMID 26315687

A Case Report of an Elderly Woman With Thrombocytopenia and Bilateral Lung Infiltrates: A Rare Association Between Diffuse Alveolar Hemorrhage and Idiopathic Thrombocytopenic Purpura.

Hashmi HR1, Venkatram S, Diaz-Fuentes G.
Medicine.Medicine (Baltimore).2015 Dec;94(50):e2235. doi: 10.1097/MD.0000000000002235.
Etiologies for diffuse alveolar hemorrhage are wide and range from infectious to vasculitis and malignant processes. Idiopathic thrombocytopenic purpura is an autoimmune disorder characterized by persistent thrombocytopenia, with a relatively indolent course in young patients, but a more complicated
PMID 26683938

Japanese Journal

臨床研究・症例報告紫斑を呈したパルボウイルスB19感染症の検討 (感染症)

小児科臨床 69(9), 1487-1493, 2016-09
NAID 40020909787

Isolation of Vibrio vulnificus Biotype I from Disease Outbreaks on Cultured Tiger Grouper Epinephelus fuscoguttatus Forsskal, 1775

魚病研究 51(Special-issue), S39-S45, 2016
NAID 130005150413

パウチ内モルセレーション法を用いた腹腔鏡下子宮筋腫核出術中の組織片飛散防止の工夫:－Apoplectic leiomyomaと診断された一例－

日本産科婦人科内視鏡学会雑誌 30(1), 280-285, 2014
NAID 130004960114

Related Pictures

★リンクテーブル★

リンク元	「100Cases 52」

「100Cases 52」

Petechia
	Petechia and purpura on the low limb due to medication-induced vasculitis
Pronunciation	petechia /pɨˈtiːkiə/ petechiae /pɨˈtiːkiiː/ ICD10 = R23.3
Specialty	Rheumatology
ICD-9	782.7
MeSH	D011693

　　[★]

☆case52　全身性の筋力低下

■glossary

筋力低下、筋無力、筋脱力 muscle weakness, muscular weakness

denture 義歯

leg 脚、下肢

bruising 打撲、打撲傷

hair follicle 毛包

edentulous adj. 歯のない。歯を失った、全歯欠損の

■症例

82歳、男性

主訴：筋力低下と全身の倦怠感

現病歴：(以前から続く)筋痛。関節痛(特に肘、手首、膝)。3週間前に転倒して足を打ち、足に局所的な痛みがある。喫煙歴なし。飲酒歴なし。服用薬なし。

既往歴：12年前に心筋梗塞になった。心筋梗塞のβブロッカーを処方されていたが、過去6年間は処方薬を持ってなかった。20年前に胆嚢摘出術。

家族歴：

社会歴：労働者として働いていた。63歳に退職。2階のアパート(in a second-floor flat)に単身で住んでいる。妻は5年前に死亡。息子が一人おり、アイルランドに在住している。息子とは3年間会っていない。

・診察 examination

　肢帯周辺の筋肉に圧痛。肘、手首、肘周辺にも圧痛。口には異常がないが舌がかなり平坦化。歯はなく、義歯は無くしている。循環器系、呼吸器系、消化器系に異常なし。下肢では右脚の脛の前面に(superficial laceration)が認められる。このlacerationは血かにじみ出ており治癒していない。下肢には出血斑が認められる部分がある。腕や脚に打撲傷がみとめられる広い範囲がある。彼が言うには、この打撲傷はどんな外傷とも関係がないとのことである。

・検査 investigation

　ヘモグロビン低値、MCV 低値

■答え

(第一パラグラフ)

・dietary historyは重要なhistoryの中でも重要な部分。

・特に今回のような症例では重要。

・今回の症例では、多くの特徴が栄養的な問題を示している。

　・家族の援助が無く、5年間widowerである。

　・2階のアパートに独りで住んでいる。get outが困難である。

　・義歯を無くしており、食べるのが痕案である。

(第二パラグラフ)

・凝固異常に関係しうる点状出血の皮疹(petechial rash)が見られるが、血小板数は正常。

・毛包の周りに分布しているかどうかを見るために皮疹を注意深く診察することが重要。　←　どういうこと？

・多くの特徴が壊血病を示唆。

・体内のビタミンC ストックは2-3ヶ月。

・壊血病の特徴：皮疹、筋肉と関節の痛みと圧痛、創傷治癒の遅延、小球性貧血

・全歯欠損している患者では、古典的な壊血病の特徴である歯肉出血はないであろう(would not be present)

(第三パラグラフ)

・血清中のビタミンCレベルは正常な患者で広い範囲にあるので、測定は難しい。

・この患者ではアスコルビン酸を経口的にビタミンCレベルを正常に戻すことで(replacement)することで、2週間で症状が消えた。

・この状況で(in this situation)、他の栄養の欠乏を探したり、退院後再発しない状況を保証するための手続きをすることが重要である。

■KEY POINTS

・特に老人では栄養歴は臨床的評価に入れるべき

・ビタミン不足はあらゆる栄養吸収不良の問題がない場合、貧しい食生活を送っている患者に起こる。

[Robbins-1] Kumar, Vinay; Abbas, Abul K.; Fausto, Nelson; & Mitchell, Richard N. (2007). Robbins Basic Pathology (8th ed.). Saunders Elsevier. p. 86 ISBN 978-1-4160-2973-1

[2] Grayson MD, Charlotte (2006-09-26). "Typhus". MedlinePlus Medical Encyclopedia. National Institutes of Health. Retrieved 2007-11-05.

[3] Fact Sheet: Tonsillitis from American Academy of Otolaryngology. "Updated 1/11". Retrieved November 2011

[Review06-4] Brook I, Dohar JE (December 2006). "Management of group A beta-hemolytic streptococcal pharyngotonsillitis in children". J Fam Pract 55 (12): S1–11; quiz S12. PMID 17137534.

[5] Ely, Susan F.; Charles S. Hirsch (2000). "Ashpyxial deaths and petechiae: a review" (PDF). Journal of Forensic Science 45 (6): 1274–1277. Retrieved 2007-09-22.

[6] "Investigating Domestic Violence Strangulation". BlueSheepdog.com. Retrieved 12 May 2011.

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petechial