![]() He returned 2 weeks ago from a 16-day visit to Zambia. Please see the rubric below for grading details.Ī 40 year old man, resident of the United States, presents to an emergency room with a 5-day history of fever, chills, nausea, vomiting, and myalgias. Each answer needs to be a minimum of 250 words in grammatically correct sentences. Review the case below and answer the questions. Janeway Lesions and Splinter Hemorrhages in a Patient With Eosinophilic Endomyocarditis. Lesson of the month 1: Splinter haemorrhages as a pointer to gastrointestinal malignancy. Santhakumar C, Faddoul C, Barker R, et al.Splinter hemorrhages of the nails: a systematic review of clinical features and associated conditions. Haber R, Khoury R, Kechichian E, et al.Clinical Observation and Follow-Up of Subungual Splinter Hemorrhages of Toenails in Chinese Adults. They can look similar to a type of skin cancer called subungual melanoma. They can occur because of a rare benign (noncancerous) tumor of your nail called onychomatricoma. There are various other causes of splinter hemorrhages. ![]() Splinter hemorrhages are also more common in people taking blood thinners such as aspirin, warfarin, apixaban or rivaroxaban. Kinase inhibitors are cancer medications that stop cancer cells from growing. Splinter hemorrhages are found in 60% to 70% of people taking kinase inhibitors such as sunitinib and sorafenib. This may be due to hemodialysis or a kidney transplant. People with chronic kidney disease also report them. Studies show that 15% to 33% of people with endocarditis have splinter hemorrhages. Endocarditis is an infection of your heart valves. Infectious diseasesīacterial infections such as endocarditis may cause splinter hemorrhages. Several diseases such as antiphospholipid syndrome and lupus can cause vasculitis. Splinter hemorrhages may be due to inflammation of your blood vessels ( vasculitis). Up to 35% of people with lichen planus reported having splinter hemorrhages. Lichen planus is an inflammatory skin condition that often results in an itchy rash. Nail psoriasis is an autoimmune disorder that causes skin cells to collect on your nails. Splinter hemorrhages are commonly seen in conditions such as nail psoriasis and lichen planus. Infections, diseases and conditions that can cause the condition may include: Skin conditions In some cases, splinter hemorrhages may be a sign of a medical condition that can damage your blood vessels. ![]() If you have a splinter hemorrhage due to trauma or an injury, it will go away on its own and not cause any concern. Stubbing your toe or getting acrylic nails put on can cause splinter hemorrhages. Trauma to your nail is the most common cause of the condition. They can happen after you injure yourself. When blood vessels under your nail bed sustain damage, splinter hemorrhages can occur. It may be a sign of an underlying condition if you have the condition in more than one nail. They usually only affect one nail in otherwise healthy people. Splinter hemorrhages occur more often in fingernails than toenails. They’ll usually move with your nail as it grows. ![]() When they first form, splinter hemorrhages appear reddish or purple, but they’ll darken to brown or black within a few days. They normally appear closer to the end of your nails, but any part of your nail may be affected. They look like tiny lines or streaks under your nail plate that run in the direction of your nail growth. Splinter hemorrhages resemble wood splinters under your nail. What does a splinter hemorrhage look like? ![]()
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