Petechiation & Ecchymoses
Barry Hedgespeth, BVSc, North Carolina State University
Karyn Harrell, DVM, DACVIM (SAIM), North Carolina State University
Petechiae and ecchymoses are red to purple discolorations of the skin or mucosa and occur due to blood vessel disruption. Petechiae are generally <3 mm in diameter and form as a result of capillary bleeding. Ecchymoses are larger lesions caused by arteriolar and venular bleeding. Most cases of petechiation or ecchymoses tend to be multifactorial with multiple mechanisms contributing to their presence.
Following are differential diagnoses for patients presented with petechiation and/or ecchymoses.
Thrombocytopenia
Immune-mediated thrombocytopenia (ie, platelet destruction)
Primary or idiopathic (most common cause in dogs, rare in cats)
Secondary
Infectious (eg, Angiostrongylus vasorum, Leishmania infantum, Anaplasma phagocytophilum [dog])
Inflammatory (eg, meningoencephalitis of unknown origin [cat], African bee envenomation [dog])
Neoplasia (eg, mast cell tumor, disseminated carcinoma, lymphoma, osteosarcoma [dog])
Drug-related (eg, gold salts [auranofin], carprofen, cephalosporins, chlorambucil, trimethoprim/sulfadiazine [dog])
Platelet consumption
Disseminated intravascular coagulation
Vasculitis
Hepatic failure
Pancreatitis
Myelosuppression
Myelodysplasia (eg, myelodysplastic syndrome with excess blasts [MDS-EB], myelofibrosis, myelophthisis [dog])
Drug-induced (eg, carbimazole, linezolid [cat], azathioprine, vincristine, chloramphenicol, cephalosporins, estrogen [dog])
Infection (eg, FeLV/FIV [cat], ehrlichiosis, parvovirus [dog])
Neoplasia (eg, lymphoma, lymphoid leukemia, histiocytic sarcoma)
Sequestration (rare; although this mechanism is frequently considered as a cause for thrombocytopenia, it is unlikely to result in petechiae or ecchymoses)
Hepatomegaly
Splenomegaly
Hypotension
Endotoxemia
Hypothermia
Thrombopathia
Inherited (rare in cats)
Glanzmann thrombasthenia (Great Pyrenees, otterhound, crossbreed dogs)
Canine thrombopathia (basset hound thrombopathia, spitz, Landseer Newfoundland)
Platelet P2Y12 receptor disorder (Greater Swiss mountain dog)
Leukocyte adhesion deficiency (LAD)-III (LAD-I variant; German shepherd dog)
Delta-storage pool deficiency (American cocker spaniel)
Acquired
Infectious disease (eg, Ehrlichia canis, E platys [dog])
Snake envenomation (eg, copperhead, other pit vipers)
Hepatic disease
Anticoagulant rodenticides
Uremia
Neoplasia (eg, essential thrombocythemia, acute megakaryocytic leukemia, chronic myeloid leukemia)
Disseminated intravascular coagulation
Monoclonal gammopathies (eg, multiple myeloma, Ehrlichia canis)
Platelet-inhibiting medications (aspirin, clopidogrel, heparin, dextran)
Idiosyncratic drug reaction (carprofen, hydroxyethyl starch, omega fatty acids)
Von Willebrand disease
Rarely causes petechiation
Vascular disorders
Vasculitis
Immune-mediated
Primary
Secondary to medication, infection, neoplasia
Infectious (eg, Rickettsia rickettsii)
Hyperadrenocorticism (dog)