Leziuni purpurice pigmentare persistente la o adolescentă de 14 ani

We present the case of a 14-year-old girl with a macular, bilateral, pigmented purpuric lesions onto the lower part of legs, that had appeared three weeks prior to the time of ad­mis­sion in the Pediatric Department II of the “Sf. Maria” Emergency Clinical Hospital for Children, Iaşi, Romania, apparently after an upper respiratory tract infection. The clinical features in­clu­ded the extended, irregularly shaped patches of pur­pu­ra and purpuric papules on the posterior area of both legs, which eventually formed a large eruption. The dif­fe­ren­tial diagnosis ruled out at the time an allergic rash, an autoimmune vasculitis, and also an infectious-induced rash. The laboratory tests were within normal range (in­flam­ma­tory, immunologic and serologic markers). The po­si­tive diagnosis was outlined by the histopathological ana­lysis, that revealed focally perivascular inflammatory in­fil­trates consisting of lym­pho­cytes and conspicuous ex­tra­va­sa­tion of red blood cells, mainly in the papillary and re­ti­cu­lar dermis. The im­mu­no­histochemical analysis was po­si­tive for CD45 in the perivascular areas, also with CD3-po­si­tive cells in the in­flam­ma­tory infiltrate. We noted the pre­sence of the CD68 in macrophagic cells, especially in the pro­found layers of the skin. These histological findings were con­sis­tent with pig­men­ted purpuric dermatosis, therefore the eruption was diagnosed as pigmented purpuric der­ma­to­sis (a rare pathology especially in children), based on cli­ni­cally pur­pu­ric pigmented lesions and the histological find­ings.