A healthy female in her 20s presents with nausea, vomiting, and fever. She was feeling great until she re-heated some leftover Taco Bell and now has no idea what might be causing her symptoms.
On exam, you are surprised to find a petechial rash around her eyes: 
This is facial purpura, which results from ruptured capillaries (likely secondary to vomiting). Other common causes include coughing, crying, or any other type of Valsalva maneuver.
Purpura is caused by extravasation of blood into the skin and subcutaneous tissues. When lesions are 2mm or less in size they are called ‘petechaie’, when larger than 10mm ‘ecchymosis’.
These lesions are asymptomatic and self-limited.
