Pen push purpura: iatrogenic nail bed hemorrhages in the intensive care unit.
Peculiar fingernail hemorrhages appeared in a febrile, comatose patient several weeks after she was admitted to the hospital. Bedside questioning of the nursing staff uncovered a frequently used neurologic examination maneuver as the cause. We suggest the term "pen push purpura" to describe this phenomenon. The clinical significance and various causes of nail bed hemorrhages are reviewed.
Cleveland Clinic Foundation, Dermatology Department, Ohio 44195-5032.
J C
JC
Pierson
K B
KB
Lawlor
W D
WD
Steck
D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D008875:Middle Aged; D009260:Nail Diseases / Q000209:etiology*; D009262:Nails / Q000293:injuries; D009460:Neurologic Examination / Q000009:adverse effects; D011693:Purpura / Q000209:etiology*