Severe Bruising and vasculitis/MCD/Other Dx

[irishponies]

Question Dear Group: I was in a car accident last Tuesday, passenger, front seat. No broken bones. Six stitches to laceration on the left forearm that the Emergency Dept doctor said was very deep. It was caused by glass. He felt around in the wound (it was injected full of lidocaine and pain free) and believed there were no glass pieces left in the wound. The wound is healing quite nicely, bandage change daily with antibiotic ointment.  Full coverage bandaging from wrist to well beyond the wound to protect it from exposure. The doctor wants to leave the stitches in for 10 full days for total healing, not the typical 7 days, the caution being due to the vasculitis (with the full daily bandaging to be done for the 10 days). The treatment plan is quite satisfactory so far, no indications of infection.

The issue is the now present (not present during doctor exam, presented the next morning) extreme bruising of both arms from biceps to wrists, top of the right hand, small area on the upper left back shoulder. The left thigh is extremely bruised on the inside (8 inches wide by 14 inches long) and outside (12 inches wide by 14 inches long) with mild bruising on the top. There is a 3 inch by 6 inch bruise on the left shin.

The main concern is some of these bruises are actually black and very slightly raised (fluid filled - lymph or blood?). Two areas on the right arm, near elbow and in mid-bicep have half-inch jet black borders on an already ugly bruise. The entire right elbow is extremely bruised, above and below.

Normally, I would just write these off as post-accident bruises and live with them. After all, I was in a car accident! Bruising is expected! Get over it!

The concern, of course, is what are the autoimmune diseases  going to do with the interruption of their playtime?

Please, Oh Learned and Experienced Group, does anyone have any recommendations? The bruises are iced and I am taking non-prescription Tylenol for the pain. Return to the emergency department? Just keep going on with life and ignore the bruises, they will go away... My rheumatologist is on vacation and I do have an April 5 appointment with her.

Info: Last Rituxan infusion was December 22, 2023. Next series is April (every 4 months) Prednisone 5 mg daily.

Thank you.

[PMRpro]

"He felt around in the wound (it was injected full of lidocaine and pain free) and believed there were no glass pieces left in the wound"

Glad it wasn't me! What was the matter with an x-ray to show glass or anything else in the wound?

The pred is probably enough to make the bruising worse. If it were me I'd at least call the ED you went to for advice and probably turn up for an eyes-on opinion.

[irishponies in reply to PMRpro]

Wow - good question why no x-ray... none was offered. I was happy to even see a doctor, I wasn't go to risk getting thrown out by making a treatment request! They can be very, very, VERY touchy in EDs here! A big chunk of glass was removed, impressive, it had made the big hole. The doctor said the wound is very deep but only need 6 stitches. Each end of the wound is open. It looks like 10 stitches would have closed it completely but like I said, as a patient you just shut up and do as you're told or you are escorted out by security. No second chances.

Thank goodness the stitched wound appears just fine, no infection, no leaking anything of any color since the third day. The several inches around the stitches are bright YELLOW. No bruise. Weird. Bruised everywhere else. If it isn't bruised, it is sore! My right calf, no bruise, is the sorest spot.

I'll call the ED. They'll probably want me to come in, that is not a problem. I actually "look" like I've been in an accident now. Before I just looked like a "glass made a hole in my arm" patient. They gave me a return appointment to remove the stitches in 10 days.

I had asked the Group about this because I wasn't sure if extreme bruising was an issue for vasculitis patients. Such as "extreme bruising in a vasculitis patient causes a xxxxxxx" and "should be treated with xxxxxx". I cannot be the first vasculitis patient to be in an accident and to receive extreme deep bruises. I thought there would be a protocol: if this happens, do this. But it seems to be like I thought: Autoimmune diseases do whatever they want to when they want to. There is no protocol nor any "handbook".

Thanks PMRpro, I'll call the ED now. I'll update later...

[irishponies in reply to PMRpro]

See my comment to JClouse below regarding the ED. Thank you.

[PMRpro in reply to irishponies]

Can't see one - are you sure it posted?

[irishponies in reply to PMRpro]

Hi - it vanished. That was a lot of work to vanish. But, I rewrote a comment. Sorry for the inconvenience. Thank you.

[PMRpro in reply to irishponies]

HU has its moments!!!!! Usually when it was a big comment ...

[JClouse]

Hi Irishponies. So glad you are Okay. I have been on prednisone for almost 2 years and it will definitely make bruises worse than they would normally be as well as they last much longer. Hope this helps.

[irishponies in reply to JClouse]

Hi JClouse, I fully understand the issues of bruising with long term use of prednisone. I have had 100s of small bruises from minor bumps over the years. This is trauma induced (car accident) bruising. No broken bones. My right arm is BLACK bruised from the bicep to the wrist; left arm wrist, forearm to elbow. Scary deep black bruising on left thigh, top, left and right. Yesterday, large bruises in other areas were appearing. Some of the black bruises are raised and fluid filled.

My question was is there a protocol for trauma induced large area deep tissue bruising for autoimmune patients. Is there anything autoimmune patients on long term use of high dose prednisone need to be aware of? I cannot be the first autoimmune patient with this issue. The answers appears to be no one knows.

At PMRpro's suggestion, I contacted the ED that put the stitches in the left forearm. The bruises were not present immediately following the accident but appeared 2-3 days after. The ED suggested waiting to be seen by the rheumatologist at the already scheduled April 5 appointment and let her discuss further care of the deep tissue bruising. The bruises will be examined be 11 days post accident.

One can only assume deep tissue bruising post-trauma (car accident) are not an issue for an autoimmune patient. I will give an update.

Thank you for your support JClouse.

[Francesbarbara]

I was involved in car accident last August. Even my GP gasped when he saw the extent and black colour of the extensive bruising - all down my trunk (I had three fractured ribs) . However, perhaps I was lucky but it disappeared quite quickly and I had no further problems. Had been on Pred for over two years at that time.

[irishponies in reply to Francesbarbara]

OUCH! My sympathies to your poor ribs! My bruises are still pretty "there". The areas that had stitches healed well. Crazy, no issues with those very deep lacerations. My friend told me Sunday that I "still look like I've been in a car accident" but I've moved on!

[Francesbarbara in reply to irishponies]

And hopefully time will do the rest. My very best wishes and I hope it will soon be a distant memory.

[irishponies in reply to Francesbarbara]

Thank you.

[irishponies]

Update: the rheumy appt - there was no comments/info/anything regarding the deep bruising and autoimmune patients which translated into English means they do know have any idea of the implications. None.

[Hidden]

IMHO, it's going to take a while for you to heal. All I have to do is brush up against anything and I get a dark red bruise. I have them all up and down my arms. Sometimes it takes them weeks to go away and even then, they leave a dark spot on my arms for some time afterwards.

[irishponies in reply to Hidden]

Yes, I look like a banana...all of my posts were in regard to very DEEP bruises from a car accident, not the usual brushing against stuff bruises we all get. As my friends say, "You LOOK like you have been in a car accident". DEEP, black nasty bruises and deep lacerations with stitches. I wanted info on whether ANY research was done on autoimmune diseases (especially ANCA-vasculitis) and DEEP bruising. I have found no info whatsoever on DEEP bruising. Thanks!