Volume 216 - Issue 9
Periorbital purpura following intense emesis
Authors: Yi‐Teng Hung and Chun‐Bing Chen
Med J Aust 2022; 216 (9): 454-454. || doi: 10.5694/mja2.51504
Published online: 16 May 2022
Published online: 16 May 2022
A 6-year-old girl presented with a 24-hour history of sudden onset, non-tender periorbital rash
A 6‐year‐old girl presented with a 24‐hour history of sudden onset, non‐tender periorbital rash. There was no history of trauma or insect bite. At the time of onset, she had acute gastroenteritis associated with several episodes of intense vomiting. On examination, well demarcated, non‐blanchable and pinpoint‐sized petechiae were noted bilaterally in the periorbital area (Figure). The mechanism of periorbital purpura is dermal capillary rupture in the loose connective tissues of the eyelids due to elevated intravascular pressure after Valsalva manoeuvre or any severe straining,1,2 in this case as a result of intense emesis. The rash self‐resolved after 4days following relief of vomiting. The differential diagnoses of periorbital purpura include intracranial aetiologies (eg, dural sinus thrombosis and superior sagittal sinus thrombosis), extracranial aetiologies (eg, vomiting, coughing and sneezing), disorders affecting orbital vasculature (eg, systemic amyloidosis and Kaposi sarcoma), trauma (eg, skull base fracture), and coagulopathies or bleeding disorders.1
Competing interests
No relevant disclosures.
References
- Gupta I, Dayal S. Periorbital ecchymosis secondary to severe coughing — a Valsalva associated phenomenon. Indian Dermatol Online J 2018; 9: 461‐462.
- Ota M. A rash localised around the eyes. BMJ 2017; 358: j3148.