CLIPP 21: 6 y/o male with bruising

Question 1

List 4 general causes of petechiae/purpura

Answer 1

Trauma
Platelet deficiency or dysfunction (e.g. immune-mediated thrombocytopenia, bone marrow infiltration or suppression, malignancy)
Coagulation abnormalities (e.g. hereditary or acquired clotting-factor deficiencies)
Vascular fragility (e.g., immune-mediated vasculitis)
-or-
Combinations of the above

Question 2

List long differential for bruising (petechiae/ purpura) and leg pain

Answer 2

Coagulation disorders
HSP
ITP
Leukemia
Viral infection
Bacterial endocarditis
Meningococcal septicemia
RMSF
SLE

Question 3

What is HSP?

Answer 3

HSP is a self-limited, IgA-mediated, small vessel vasculitis that typically involves the skin, GI tract, joints, and kidneys.

Often presents in an otherwise well appearing child with bruising and leg pain (due to arthritis).

In roughly 50% of cases, a URI precedes the diagnosis of HSP.

Question 4

Can viruses cause a petechial rash?

Answer 4

Yes, particularly enteroviruses

Question 5

Describe the rash pattern in RMSF

Answer 5

The rash of RMSF is often petechial, and starts on the extremities before moving centrally.

Question 6

Lymph nodes > what size are concerning for disease?

Answer 6

> 2cm

Question 7

Palpable lymph nodes where are concerning for lymphoma?

Answer 7

Supraclavicular

Question 8

What is lymphadenitis?

Answer 8

Infection of the lymph node itself

Characterized by Tenderness, warmth, fluctuance, overlying erythema or edema suggest local infection or infection of the node itself

Question 9

Major general causes of hepatomegaly (5)?

Answer 9

Hepatomegaly may occur as a result of inflammation (e.g., viral hepatitis), infiltration (e.g., leukemia/lymphoma), accumulation of storage products (e.g., glycogen-storage disease), congestion (e.g., congestive heart failure) or obstruction (e.g., biliary atresia).

Question 10

Most frequent cause of splenomegaly in children?

Answer 10

Epstein-Barr virus
Cytomegalovirus
Bacterial sepsis
Endocarditis

Question 11

Two systemic inflammatory diseases that can cause splenomegaly?

Answer 11

LSE

Juvenile idiopathic arthritis

Question 12

Common cause of hemolysis and splenomegaly?

Answer 12

Sickle cell disease

Question 13

Hallmark of HSP?

Answer 13

Non-thrombocytopenic purpura

Question 14

Signs and symptoms of HSP?

Answer 14

1/3 present with renal involvement –> hematuria
Arthritis/arthralgias (mostly knees and ankles) in 75%
Colicky abdominal pain; 50% may develop GI bleeds with guiac positive stool
2/3rds with URI

Question 15

Treatment for HSP?

Answer 15

Controversial role of corticosteroids

Question 16

HSP with low platelet count?

Answer 16

ITP

Question 17

What causes ITP?

Answer 17

ITP is caused by the binding of an antiplatelet antibody to the platelet surface, leading to removal and destruction of platelets in the spleen and liver. It is the most common cause of isolated thrombocytopenia in otherwise healthy children.

Question 18

Classic presentation of intussiception

Answer 18

Paroxysms of severe abdominal pain with inconsolable crying
Passage of “currant jelly” stool containing blood and mucus
Palpation of a “sausage-shaped” mass in the right abdomen

Question 19

Classic diagnosis and treatment of intussusception?

Answer 19

Air or barium enema

Question 20

Recurrence rate of HSP?

Answer 20

30%

Question 21

Incidence of ALL peaks at what age?

Answer 21

4 years old