Wednesday, August 31, 2011

Raccoon Purpura

I received this email from an otherwise healthy 23 yo woman who I saw a month ago for an unrelated problem: "I was wondering if you might have any insight to another skin problem I am having. After receiving some terrible news, I have popped a number of blood vessels around my eyes and face to the the point of having dark purple bruises around and on my eyes. I do not know what to do. I look like a victim of abuse and would like to heal my face as soon as possible."
Discussion: One can see eyelid purpura and petechiae with a number of pathologic processes (amyloidosis, coagulopathy) but also after valsalva maneuver, violent vomiting, coughing. I suspect the latter and need more information from the patient. Any thoughts?

Reference: Anesth Analg. 2007 Dec;105(6):1561-3, table of contents.
Periorbital ecchymoses during general anesthesia in a patient with primary amyloidosis: a harbinger for bleeding? Available Free Full Text Online
Weingarten TN, Hall BA, Richardson BF, Hofer RE, Sprung J.
Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA.
Abstract: Primary amyloidosis is a result of proliferation of a population of plasma cells that leads to an increased secretion of monoclonal immunoglobulins (amyloid). Amyloid protein infiltrates increase capillary fragility. Such capillaries can burst, even after minor stress, resulting in periorbital hemorrhage. We describe a 64-yr-old man with primary amyloidosis who underwent general anesthesia. His eyes were gently closed with tape. Upon removal of the tape bilateral periorbital purpura was noted. All coagulation studies were normal. The periorbital hemorrhage was attributed to amyloidosis-induced capillary fragility.


  1. Based on the history there is a clearly a history of trauma. She did not mention how long the purpura had been there but it's less than a month old. I would watch and see and in the meantime, advise her to avoid excessive exposure, sunblock and topical fusidin ointment at night. Not sure if we should go further beyond that unless she did not respond to this. Other differentials to consider at the back of the mind are drug allergy, irritant dermatitis, allergic dermatitis to topicals, amyloidosis, coagulopathy. Oh yes, bring her in for a consult at a early appointment.

  2. Babak SoltaniSeptember 04, 2011

    I suppose clinically it is purpura maybe due to swimming eye glassess that causes negative pressure

  3. I think valsalva maneuver would be the most likely pathologic pocess.

  4. Serious bouts of crying will do this


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