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Red spots just under my chest: anyone know what they might be?

Hip

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I've had a group of mysterious red spots just under my chest on my left side for at least 10 years I think, probably as long as I have had ME/CFS.

These spots are ever-present: they never go away, and over time they barely change (the exact same cluster of spots in the same positions is maintained for years). But they are only at one place, just under my left chest. They are not itchy (although very occasionally there might be a very mild itch in the spot area).

I believe these sort of red spots are called petechiae. I attach 4 pictures of these spots below.

I am wondering whether these red spots might be indicative of some condition, perhaps an infection of some sort. But note these spots have not cleared up or improved after various courses of antibiotics taken for a few weeks.

Anyone have any ideas what they might be?


One Lyme website (not an authoritative medical site) had a picture of similar red spots, and said these were caused by Babesia infection (Babesia is a malaria-like parasite), which I have not been tested for (and I understand it is hard to test for).



EDIT: @sometexan84 mentioned guttate psoriasis, and looking at pictures of guttate psoriasis, that could well be what I have (especially because I previously had regular psoriasis).

Psoriasis of course is an autoimmune skin condition. I may have even found a treatment for my psoriasis — see this post.



Red Spots Just Below My Chest
Spots on skin 4.jpg




See the other pictures of these red spots below:
 

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Learner1

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Interesting. According to the Mayo Clinic:
Infectious diseases
Petechiae may be caused by any of a number of fungal, viral and bacterial infections, including:

  1. Cytomegalovirus (CMV) infection
  2. Endocarditis
  3. Meningococcemia
  4. Mononucleosis
  5. Rocky Mountain spotted fever
  6. Scarlet fever
  7. Sepsis
  8. Strep throat
  9. Viral hemorrhagic fevers
Other medical conditions
Petechiae may also be caused by noninfectious medical conditions. Examples include:

  1. Vasculitis
  2. Thrombocytopenia (low platelet count)
  3. Leukemia
  4. Scurvy (vitamin C deficiency)
  5. Vitamin K deficiency
Many of these sound related to ME/CFS
 

Hip

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Interesting. According to the Mayo Clinic:
Thanks. I've seen some of these lists of what might cause petechiae, but could not find anything that seemed likely to explain my red spots. This is quite a comprehensive list of causes of petechiae and purpura spots/rashes

I presume things like cytomegalovirus, Epstein-Barr virus and scarlet fever would only cause petechiae in the acute active infection stage, and then once the infection is cleared up, the petechiae would disappear. So I would not think these acute infections apply in my case.

I do have chronically high IgG antibodies to cytomegalovirus, but I am not sure if that counts as a normal type of active infection.



Typhus can apparently cause a petechiae rash looking similar to mine, but typhus clears up very quickly with doxycycline, an antibiotic I have taken several times, but it did not clear the spots.
 
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pattismith

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Do the spots keep the same place, or did they move during your ten years with ME?

Did you see a dermatologist, and was he willing to do any biopsy?
 

Hip

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Yes, I did briefly look at that thread, thanks. I had a number of skin changes after I caught my ME/CFS-triggering virus, including fine crêpe paper-like wrinkles on my skin, lots of seborrheic warts appearing, and a few cherry angiomas.

But I am more interested in these red spots that I pictured above, as these could be indicative of some condition or infection which if identified, I may be able to treat, and that might lead to an overall improvement in health.
 

Cipher

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One Lyme website (not an authoritative medical site) had a picture of similar red spots, and said these were caused by Babesia infection (Babesia is a malaria-like parasite), which I have not been tested for (and I understand it is hard to test for).
I know very little about Babesia, but it seems like serology is sensitive for chronic Babesiosis, at least when using IFA:

Transfusion-transmitted Babesiosis in the United States: Summary of a Workshop

Antibody detection by IFA test is the current immunodiagnostic test of choice. The CDC uses an anti-humanimmunoglobulin conjugate that reacts with all human immunoglobulin classes, while some other laboratories use immunoglobulin (Ig)G- and IgM-specific conjugates. IFA sensitivity and specificity for B. microti were initially reported to be 100%,19 followed by the report of 88% to 96% and 90% to 100%, respectively, in an interlaboratory collaborative evaluation.20 Except during the early acute stage of infection (before seroconversion), antibody detection by IFA is currently the most sensitive assay to identify B. microti infection in persons with chronic low levels of parasitemia (e.g., asymptomatic blood donors). The finding of an IgM-positive reaction does not necessarily imply that a person was recently infected because the duration of IgM antibodies is not known.

Multiplex Assay Detection of Immunoglobulin G Antibodies That Recognize Babesia microti Antigens

Antibody assays can identify asymptomatically infected individuals and individuals in the chronic late phase of infection (14, 28). However, antibody responses among the three dominant human pathogens of humans, B. microti, B. duncani, and B. divergens, appear to be species specific (7, 14, 17, 18, 41), and three separate assays would be required to conclusively rule out a diagnosis of infection with Babesia sp. PCR, while more sensitive than slide microscopy (29), has a reported limit of detection of 10 piroplasms per milliliter of whole blood (50% confidence interval) (57), and cases of transfusion-transmitted babesiosis have been documented from PCR-negative, antibody-positive blood donors (23, 33, 53).
In Europe it seems like Babesia divergens, Babesia venatorum and Babesia microti are endemic. ref1 ref2 ref3 ref4 ref5

Unfortunately it seems like antibody tests for Babesia venatorum are not available commercially, at least I haven't found any. Commercial PCR tests might include Babesia venatorum.

An IFA antibody test for Babesia divergens and Babesia microti is available at IMD Berlin, but the actual analysis is performed at an unknown external lab, as indicated by the little ° symbol.
 
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Hip

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Do the spots keep the same place, or did they move during your ten years with ME?

Did you see a dermatologist, and was he willing to do any biopsy?
My spots have kept in exactly the same area over several years. I have pictures of these spots that I took two years ago, and each spot is the same place it was two years back. So the spots are constant, like an astronomical constellation of stars which keeps the same pattern.

My red spots are only found in one area on my body, which is an area about 10 cm in diameter, located at the top of my belly and just under my chest, on my left side only.

I have not seen a dermatologist, because these petechiae red spots do not concern me, they do not cause any pain or itchiness. However, if these red spots are indicative of an underlying condition, then it might be interesting to see a dermatologist, and get a diagnosis.



I am not entirely sure that my red spots can be described as petechiae or purpura though, because by definition petechiae or purpura are non-blanching (meaning the color does not fade when the rash is pressed with a drinking glass — see this video).

But with my spots, much of the red color fades when I press the side of a drinking glass on them.
 

Hip

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I know very little about Babesia, but it seems like serology is sensitive for chronic Babesia, at least when using IFA
Thanks for those links.

I don't know much about Babesia either, but looking at this CDC recommendations for diagnosis, it mainly refers to looking at blood samples under the microscope to detect this parasite in red blood cells. The CDC just mentions in passing using other tests like molecular methods or serology (antibody) tests, but they do not seem to think highly of these tests, otherwise they presumably would point to these tests in the first instance.

And this website points out the difficulties in finding reliable testing:
Babesia can also be difficult to diagnose with current testing. The parasite was detected microscopically in as few as one-third of patients with Babesia. Specific amplifiable DNA and IgM antibody were more likely to be positive. The reliability of tests for Babesia in actual practice remains to be determined.
So it looks like there is a lot of uncertainty with current testing techniques.


It might just be easier and cheaper for me to take the antimicrobial treatment for Babesia, which is just atovaquone + azithromycin for 7 to 10 days, which are both usually well tolerated drugs. I've taken azithromycin before without any problems.

That might be easier rather than going though all the complexities and uncertainties of testing. If my red spots disappear after antimicrobial treatment, then there's a good chance it was Babesia (or perhaps some other organism susceptible to atovaquone).
 

Cipher

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The CDC just mentions in passing using other tests like molecular methods or serology (antibody) tests, but they do not seem to think highly of these tests, otherwise they presumably would point to these tests in the first instance.
I wouldn't jump to that conclusion. This quote is from the CDC’s Division of Parasitic Diseases and Malaria:
Diagnosis of Babesia infection should be made by detection of parasites in patients’ blood smears. However, antibody detection tests are useful for detecting infected individuals with very low levels of parasitemia (such as asymptomatic blood donors in transfusion-associated cases), for diagnosis after infection is cleared by therapy, and for discrimination between Plasmodium falciparum and Babesia infection in patients whose blood smear examinations are inconclusive and whose travel histories cannot exclude either parasite.

The indirect fluorescent antibody test (IFA) using B. microti parasites as antigen detects antibodies in 88-96% of patients with B. microti infection. IFA antigen slides are prepared using washed, parasitized erythrocytes produced in hamsters. Patients’ titers generally rise to ≥1:1024 during the first weeks of illness and decline gradually over 6 months to titers of 1:16 to 1:256 but may remain detectable at low levels for a year or more. Specificity is 100% in patients with other tick-borne diseases or persons not exposed to the parasite. Cross-reactions may occur in serum specimens from patients with malaria infections, but generally titers are highest with the homologous antigen.
 

Booble

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I don't think Hip's spots are petechiae. Petechiae are blood spots under the skin. The bigger ones which I think are called pupura--- will bulge up a bit so they seem like the are over the skin. There is only one of the spots in your photo that looks possibly like one. The others definitely don't look like them at all.
 

Hip

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Could these be some kind of excema or psoriasis or something fungal?
That's an interesting suggestion. Could be eczema or psoriasis I guess, although I understand these conditions tend to come and go, but this cluster of red spots is constant, never changing or moving.

Probably not fungal, as I have tried taking an antifungal (itraconazole 200 mg daily for 2 months). But I guess I could try some topical antifungals.
 

Booble

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Oh boy, they look really different in photos than real life. I'll need to take another look at your photos.
 

pattismith

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My spots have kept in exactly the same area over several years. I have pictures of these spots that I took two years ago, and each spot is the same place it was two years back. So the spots are constant, like an astronomical constellation of stars which keeps the same pattern.
In this article, it is said that petechia don't exceed 4 mm, are they?

It is also said that "Palpable purpura takes longer to heal due to the presence of inflammatory cells and immune complex deposits that lead to vascular occlusion"

In this other article:

"Vascular damage may result in persistent and localized purpura, often with an erythematous and palpable inflammatory component."

So if you have palpable petechia, the cause may be inflammatory vascular damages, and the known causes for these vascular damages should be investigated.

The first article gives a table with these possible causes for vascular damages, the list includes:

-pigmented purpura / capillaritis
-vasculitis
-vascular occlusive syndromes
-vessel wall support problems

this makes much things to investigate I guess...
 
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Art Vandelay

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I presume things like cytomegalovirus, Epstein-Barr virus and scarlet fever would only cause petechiae in the acute active infection stage, and then once the infection is cleared up, the petechiae would disappear. So I would not think these acute infections apply in my case.
After getting EBV, I ended up with a large amount of spots like the ones shown by @Hip on my ankles and knees. They are still there 20 years later.

I also got what looks like many petechiae (or perhaps cherry angiomas) across my torso at the same time. My EBV reactivated last year and I ended up with even more of these spots on my thighs.
 

Tammy

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Yes..............I had those same red spots (not as many) spread over my torso. Sometimes a few of them would weep a clear liquid. In the bottom right picture it looks like the spot on the right is filled with a clear liquid? Have any of yours every wept? Not all of mine did. Mine eventually went away. I have 1 left.