A case of Postural‐Induced Peri‐Orbital Petechiae

A seven-year-old boy with no significant medical history presented with symmetric bilateral periorbital petechiae (Figure 1). The rash was noticed an hour before arrival and was not accompanied by pain or other medical complaints. It was noted that the boy spent at least 10 minutes hung upside down on a stress bar in the playground earlier that day. No other findings were evident on physical examination. The rash resolved spontaneously within five days. Exercise-induced petechiae and purpura are benign conditions mostly described following straining activity such as high-intensity exercise, vomiting, and coughing.1, 2 It is often described in the lower extremities and is associated with warm weather.2, 3 The elevated intra-vascular pressure causes extravasation of red blood cells leading to the typical cutaneous manifestations.1-3 This report presents a first case of non-exercise-induced periorbital petechiae secondary to postural vascular congestion. Correctly diagnosing this benign condition may help prevent costly workups and unnecessary anxiety.