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- most common type of panniculitis, reddish lumps on pre-tibial area, usually very
tender and usually preceded by fever and malaise. Lumps may be very large and
numerous and are initially acutely inflamed, typical course 3-6 weeks, new lesions may
appear. Autoimmune disorder?
- female age 20-30 mostly, seen in Sarcoid (Lofgren's syndrome),
some infections (tb, yersinia, other more common), pregnancy, OCP, drugs (sulfa, gold)
- may be preceded by viral syndrome features, joint pains in half, usually knee and may
- possible tests: throat swab, tb, CBC, ESR, ASO, CXR (sarcoid, consider ACE level),
- Rx: potassium iodide? (does that really work?)
- don't confuse (sound alike) with unrelated vasculitis polyarteritis
- lab evaluation: CBC with diff, ESR, chem 21, TSH, ANA + RF (if arthritis/myalgia), U/A
- if depression: prozac, zoloft
- if not depression: elavil 10-20 mg hs
- see also somatization disorder
- Heat-Related Illnesses - 9/1/98
- Heat cramps: replace sodium, oral rehydration with 1 tsp salt/qt
- Heat syncope: replace fluids
- Heat exhaustion: core temp < 104.9, sick, visual disturbance. Oral rehydration
1L/hour for several hours.
- Heat stroke: core temp > 104.9, mental status changes, seizures, hypotension, EKG
changes, coagulation abormalities, very high ALT/AST, renal failure with ATN,
vomiting. 5-10% mortality with treatment. IV fluids, cooling, transport to ED.
- Prozac (long t1/2) + other SSRI
- hyperalertness, agitation, confusion, restlessness
- myoclonus, hyperreflexia, diaphoresis, shivering, death
See also: An Approach to Diagnosis
and Initial Management of Systemic Vasculitis - AFP Oct 1999. As of 2001 it's not
clear what the relationship (if any) is between the vasculitides and the clinically
somewhat similar thrombotic microangiopathies (TMA) such as Hemolytic-Uremic
- flu-like with palpable rash - leukocytoclastic angiitis causes purpura, sometimes with
ulceration, in lower extremities.
- may have urticaria, peripheral neuropathy
- respiratory (danger pulmonary hemorrhage, See ANCA)
- obliterative endarteritis can produce petechiae
- Henoch-Schonlein purpura (age @ 5), cryoglobulinemia
(Hepatis C, low C4 normal C3), lupus, rheumatoid, Sjogren's, Behcet's (Japan),
Goodpasture's, serum-sickness, drug-induced (pen, sulfa, allopurinol,
thiazide, quinolones, etc), infection-induced
Other: Paraneoplastic, Inflammatory Bowel disease
Author: John G. Faughnan.
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