Acute glossitis and multiple lesions

25-year-old female, previously healthy, p/w acute glossitis initiating a few hours ago, painful to touch and movement, unable to speak. She self-medicated with amoxicillin (1 pill). Presenting with multiple lesions described next with sialorrhea. About a 1 and a half month ago: she visited for petechiae, purpura and ecchymoses spread all over her extremities and torso (the biggest ones measured as of today where 5x5cm) diagnosing her with ITP. She also had 1 episode of gingivorrhagia.CBC normal. She has bee treated with oral, topical and IV steroids. As follows: IV Dexamethasone for 5 days (she completed only 3 days of therapy), prednisone 50mg per day for 14 days (she completed only 7 days); lastly, increased dose to 100mg a day (she took that dose for 3 days). Later, she used multiple (6) topical steroids (unknown). Supposedly, there was a decrease in the amount/size of lesions, but not all of them subsided. PMH: none Meds: amoxicillin, steroids, other meds she cannot recall. Fam Hx: none Allergies: none Vital signs: T: 36.6C HR: 116 BP: 130/70 RR:19 SpO2: 99% on RA Weight:160 lbs Height: 1.62mts General examination: well-appearing besides the lesions all over her body Extremities/Skin: multiple non-blanching, flat, purple lesions consistent w/ petechiae, purpura, and ecchymoses distributed as shown in the pictures. Hematology: WBC: 12.3 (Neu 69.4%, lymph 23.8%, mid 6.8%), Hg: 9.6, MCV:99.6, MCH: 31.4, RDW: 19.0%, HCT: 30.3%, Plt: 255,000 ESR: 54, CRP: 16 mg/L Chemistry: Gluc: 114, Crea: 0.88, AST: 25, ALT: 50, Na: 142, K: 3.9, Cl: 104. Please give your opinion

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Beautiful clinical history.. Lot of thanks sir. Dd. Immune thrombocytopenia in resolution phase. Henoch Schonlein purpura Glanzman s thrombasthenia. Coagulopathy... Sug. Coagulation profile... PT. ApTT. WbCT. Clot retraction test. Platelet morphology and platelet function tests. Follow up. HESS capillary fragility test. Bone marrow should not be attempted in view of bleeding.
* ITP ** Drugs induced Vasculopathy Needs further investigation and evaluation to conclude and treatment plan. Reassurance and counciling required. Self medication strictly prohibited advised.
Thanks Dr Shital Sorekar.
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IT'S A..CASE OF.. ? VASCULOPATHY.. ? LIVEDOID VASCULOPATHY.. ? ITP .. ? HSP.. NEED'S.. BLOOD CBC CT BT PT.. BSR .. HBA1C.. CAPILLARY FRAGILLITY TEST .. TISSUE HISTOPATHOLOGICAL STUDY..
Tnx Dr Shivraj Agarwal sir
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Probabely ITP D/ds SJ syndrome TEN Tropical spru
Agreed with Dr.Neelkanth P Sir.
?SJS SYNDROME
Thanx dr Kute Ankush
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Agree with Dr.M.M.Bandhyapdhya Sir There appears to be element of vasculitis in this with l element of vasculitic urticaria. Additional studies like ANA profile with ANCA studies are advisable.
Thanks sir.. I agree to your points
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ITP Vasculopathy HSP Needs evaluation
continue treatment ITP
Petechial Hemorrhage

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