Paeds: Case presentations Flashcards
History:
2 year old boy. Presents to paediatric rapid referral clinic with a worsening of eczema. Eczema diagnosed at 6 months old. Previous treatment with emollients and topical steroids. Past 3 days, eczema has deteriorated and become more itchy. The boy also has asthma, treated with beclomethasone and salbutamol. His mother had eczema as a child, father has hay fever.
On examination:
well hydrated, temperature is 38.3oC. Itchy and miserable. widespread eczema all over body. Worst on his face, hands and arms where the skin feels moist. A number of vesicles and punched out lesions can be seen on the face, hands and arms. There are also pustules and some areas of honey coloured crusting in those areas. Lesions have coalesced insome areas. Marked scratching. Eyes are puffy. The eyes appear normal. Cervical, axillary and inguinal lymphadenopathy.
Investigations:
Anaemia, Raised White cells. Raised CRP.
Most Likely diagnosis?
Eczema Herpeticum
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dDx: Bacterial infection of eczematous skin
History
Noah is an 18-month-old boy who has been referred by his general practitioner (GP) to the paediatric emergency department (ED) with a non-blanching rash on both legs and abdominal pain. His mother noticed the rash 2 days ago, when it was just a few dark spots on both feet, but became concerned when the rash seemed to spread to cover his shins and calves. While he was waiting to see his GP, he began to complain of pain in his tummy, and vomited once.
He has not had a fever during this time or been systemically unwell. He has also been com- plaining of intermittent pain in his legs for the past 1 week. His mother states that, about 4 weeks ago, he had a cold that lasted for 3 days. He has grown and developed normally since birth.
Examination
Noah is apyrexial. His heart rate is normal at 120 beats/min, and he is warm and well perfused. He has a soft but diffusely tender abdomen, but no palpable masses. There is a widespread rash consisting of purple, round, palpable lesions, mostly <1 cm in diameter, distributed on both lower legs, and coalescing around the feet and ankles. They are not painful or itchy. He has no pain or inflammation in his joints. There are no signs in the other systems. His blood pressure is within the normal range, at 88/52 mmHg (Figure 48.1).
Blood tests and a urine dipstick analysis are performed.
CRP is raised
Urine dipstick – Blood ++, Leucocytes +, Protein ++, Nitrite negative
Most likely diagnosis?
Henoch-Schonlein Purpura (HSP)
