Clinical Snapshot
Valsalva Purpura After Gastroscopy
; ;
A 34-year-old patient with cystic fibrosis wished to undergo a gastroscopy for refractory dyspepsia without analgosedation to stay fit to drive. He did not tolerate the endoscopy well and had a severe gag reflex. After the procedure, multiple petechiae and purpura were noted on his face and neckline. These faded over the next two weeks. The patient had no thrombocytopenia, coagulation disorder or other competing etiologies. Purpura (skin hemorrhage > 2 mm) and petechiae (up to 2 mm) can be caused by dermal capillary rupture due to the intrathoracic pressure increase associated with Valsalva maneuvers. Valsalva purpura have rarely been described. They can be the result of lung function test maneuvers, childbirth, convulsions, weight lifting, coughing, vomiting, and, for example, blowing up balloons. The differential diagnosis includes impaired vascular integrity (vascular defects, vasculitis, infections, and toxin-mediated) and primary or secondary coagulopathy (thrombocytopenia, thrombopathy and other coagulation defects). The use of non-steroidal anti-inflammatory drugs plus viral upper respiratory tract infection may have increased the risk of bleeding. Rarely, leukocytoclastic vasculitis can cause purpura in patients with cystic fibrosis; in the case reported here, it seems to be an unlikely differential diagnosis.
Johannes Till Othmer, Dr. med. Laura Hoffmann, Prof. Dr. med. Mirjam Stahl, Sektion CF, Klinik für Pädiatrie m. S. Pneumologie, Immunologie und Intensivmedizin, Charité-Universitätsmedizin Berlin, Johannes-Till.Othmer@charite.de
Conflict of interest: MS is Chairman of the Board of the Forschungsgemeinschaft für Mukoviszidose (FGM, Research Association for Cystic Fibrosis) within the Mukoviszidose e.V. (German Cystic Fibrosis Association). The remaining authors declare no conflict of interest.
Translated from the original German by Ralf Thoene, M.D.
Cite this as: Othmer JT, Hoffmann L, Stahl M: Valsalva purpura after gastroscopy. Dtsch Arztebl Int 2023; 120: 362. DOI: 10.3238/arztebl.m2023.0252
