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 a 6 YO BOY WITH MACULES......  



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Author7 Posts
  #1

CASE:A 6 yo boy has not been feeling well for the last week.He had a low grade temp, joint pains, and abdominal pain with occasional vomiting.His mother became more concerned this morning when she noticed he had a rash on the back of his legs.He appears tired but , does not seem to be in acute distress.His VS: TEMP—100.6F,pulse---100/min,RR---20/min, BP---100/70 mm Hg.Eyes r anicteric & tympanic membranes are normal.Abdomen soft with active bowel sounds and mild diffuse tenderness, no mass or organomegaly.there r well defined hyperemic macules scattred over the backs of the legs & buttocks, with a rare lesion on the back of the arms.Some r raised and palpable and
none blanch with pressure.Other PE is normal.LABS: WBC---9900/mm3,hct—42%,platelets---320,000/mm3, stool for occult blood positive,ESR---18 mm/h,U/A---2+protein with RBCS and WBC casts………

Most likely diagnosis……….
1.ITP
2.KAWASAKI DS.
3.RMSF
4.HENOCH-SCHONLEIN PURPURA
5.SYSTEMIC JRA
6.MENINGOCOCCEMIA

The best next step in treatment……
1.IVIG
2.ORAL.DOXYCYCLINE
3. NSAIDS
4.IV CORTICOSTEROIDS5. IV CEFTRIAXONE
6. IV INFLIXIMAB




  #2

this is HENOCH-SCHONLEIN PURPURA ...and the treatment would be be immunosupression ....so out of the choices i can think of CORTICOSTERIODS and CEFTRIOXONE....


  #3

yes tasha, absolutely correct........... grin grin
but iam sorry i guess, my 5th option clubbed with 6th one while typing & they r looking like they r together, but ceftriaxone is my 5th option & cortocosteroids my 4th.........and of course 4th one is the answer.........
Henoch schonlein purpura is an IgA mediated vasculitis which involves small vessels, GIT, Renal, CNS systems.......
Any pt. presenting with GIT OR CNS involvemnt needs to be given corticosteroids, otherwise symptomatic t/t is enuf......
and in this pt. with abdominal/GIT symptoms, u shud always r/o intusussception or bleeding/hemorrhage.............so, surgical evaluation is mandatory!!!!!!!!!so, admit the patient!!!!!!!!!!! grin grin


  #4

The Q states: the most likely Dx...based on that, treatment would be Steroids alone since the pt has abdominal sx. There is no need to admit this pt. There is no need for ceftriaxone.


  #5

well Schwed...............who says we need to give this pt. CEFTRIAXONE?????????????? :roll: :roll:
And tasha got confused and had to say that, coz she thought steroids and ceftriaxone go together in my list, like how u JUST THOUGHT!!!!!!!!!!
My 5th option is ceftriaxone and 4th is corticosteroids and so, the answer is 4........STEROIDS......... grin grin
And i've already mentioned this in my previous post........SCROLL UP AND READ PLZZZZZZZZ,ok?
And this pt. NEEDS admission coz of the suspicion of INTUSSUSCEPTION in a pt. of HENOCH SCHONLEIN purpura presenting with abdominal symptoms!!!!!!!!!!!!!!!!! grin grin


  #6

what is the exact etiology of this disease and how does it lead to fever?


  #7

No one knows what causes it. We do know that it often follows a viral respiratory infection. It seems to be some kind of allergic reaction to the virus. It has also been seen following Strep throat, prescription medicines, bee stings, chemical toxins, cold exposure, and food allergies.

It is a form of blood vessel inflammation or vasculitis,i think this inflamation leads fever





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