Thoracocervicofacial Purpura as a Presenting Symptom of Seizure Disorder: A Case Report

Abstract

Introduction: Postictal thoracocervicofacial purpura (PTP) is a rare clinical sign after a seizure episode and may be the only objective sign seen in patients who are unaware of their own seizure disorder. Moreover, it can be the only reason a patient seeks medical care after a seizure activity. Case Presentation: Herein, we report a 23-year-old, living alone and not known to have any medical illnesses, who presented to our emergency department complaining of asymptomatic purpuric facial rash extending to his neck and upper chest that started suddenly when he woke up that morning. Tongue and distal lateral thigh erosions were also noticed during physical examination, as well as conjunctival hemorrhage. In addition, the patient stated that he experienced similar prior episode of purpuric rash over the face, and disappeared uneventfully within 2 weeks. Blood work was remarkable for elevated urine creatinine (21,692 mg/L) and creatine kinase (1,207 mg/L). Given his clinical features and initial laboratory results, a diagnosis of PTP was made. Conclusion: Patients who present with petechial rash over the chest, neck, malar area along with conjunctival hemorrhage as an only complaint should be suspected to have or evaluated for seizure disorder.

Keywords

• thoracocervicofacial purpura
• valsava
• conjunctival hemorrhage
• nocturnal
• seizure