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Rash and fever in a 14-month-old girl

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A careful examination of this toddler’s rash and a thorough history led us to the correct diagnosis.


 

References

A 14-MONTH-OLD GIRL was brought to our medical center with a widespread pruritic eruption and fever that she’d had for 2 days. She had a temperature of 103.2° F, heart rate of 166 beats/min, respiratory rate of 32 breaths/min, and an oxygen saturation level of 100%.

On physical examination, the toddler was active, appeared well-nourished, and was not in acute distress. She had ill-defined, polycyclic, urticarial plaques with subtle, purpuric, dusky-appearing changes distributed widely over her face, trunk, and extremities (FIGURE 1A AND 1B). She had no signs of arthritis and did not exhibit an antalgic gait. She was otherwise healthy and had no personal or family history of connective tissue disease.

Lab results showed a slightly elevated erythrocyte sedimentation rate (ESR) (16 mm/hr) and mild thrombocytopenia (platelet count: 109,000/mcL). Complete blood count, comprehensive metabolic panel, and uric acid tests were unremarkable. Nine days earlier, the toddler had been diagnosed with otitis media and prescribed oral amoxicillin 50 mg/kg/d taken in 2 doses.

WHAT IS YOUR DIAGNOSIS?
HOW WOULD YOU TREAT THIS PATIENT?

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