7 CLINICAL J R Coll Physicians Edinb 2016; 45: 7 http://dx.doi.org/10.4997/JRCPE.2016.102 © 2016 Royal College of Physicians of Edinburgh Petechial haemorrhage of the face Images in Medicine 1 LD Macphee, 2 C McCormack, 3 PK Myint 1 Medical Support Nurse, 2 Consultant in Geriatric Medicine, 3 Professor of Medicine of Old Age, Aberdeen Royal Infirmary, Aberdeen, UK DECLARATION OF INTERESTS No conflict of interest declared CONSENT Written consent was obtained from the patient Correspondence to PK Myint Polwarth Building School of Medicine and Dentistry University of Aberdeen Foresterhill Aberdeen AB25 2ZD UK e-mail [email protected] An 89-year-old lady was admitted to an acute geriatric assessment unit with increasing shortness of breath over a few days and an episode of violent vomiting on the day of admission. She was on warfarin for atrial fibrillation and international normalised ratio on admission was 5.8. The petechial haemorrhages which were confined to her face were noted by others. She was systematically well and there were no other associated symptoms. Widespread petechial haemorrhages are classically seen in haemorrhagic fevers; those confined to the face can be seen in asphyxia as a result of strangulation or hanging by the neck. In this lady’s case a diagnosis of petechial haemorrhage of the face secondary to violent vomiting and high international normalised ratio was made. Her rash faded over a couple of days. FIGURE 1 Petechial haemorrhage of the face If you have an Image in Medicine that you feel would be of interest to a general medical postgraduate readership, please conact the editorial office. Please note, patient consent must be obtained where appropriate

Declaration of interests clinical Polwarth Building School ... · 7 clinical J R Coll Physicians Edinb 2016; 457: © 2016 Royal College of Physicians of Edinburgh Petechial haemorrhage

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clinicalJ R Coll Physicians Edinb 2016; 45: 7

Petechial haemorrhage of the face

Images in Medicine

1LD Macphee, 2C McCormack, 3PK Myint1Medical Support Nurse, 2Consultant in Geriatric Medicine, 3Professor of Medicine of Old Age, Aberdeen Royal Infirmary, Aberdeen, UK

Declaration of interests No conflict of interest declared

consent Written consent was obtained from the patient

Correspondence to PK Myint Polwarth BuildingSchool of Medicine and DentistryUniversity of AberdeenForesterhillAberdeen AB25 2ZDUK

e-mail [email protected]

An 89-year-old lady was admitted to an acute geriatric assessment unit with increasing shortness of breath over a few days and an episode of violent vomiting on the day of admission.

She was on warfarin for atrial fibrillation and international normalised ratio on admission was 5.8. The petechial haemorrhages which were confined to her face were noted by others. She was systematically well and there were no other associated symptoms. Widespread petechial haemorrhages are classically seen in haemorrhagic fevers; those confined to the face can be seen in asphyxia as a result of strangulation or hanging by the neck.

In this lady’s case a diagnosis of petechial haemorrhage of the face secondary to violent vomiting and high international normalised ratio was made. Her rash faded over a couple of days.

Figure 1 Petechial haemorrhage of the face

If you have an Image in Medicine that you feel would be of interest to a general medical postgraduate readership, please conact the editorial office. Please note, patient consent must be obtained where appropriate