This little sixteen month old boy presents today with a 1 day history of a worsening rash. He started amoxicillin 8 days ago for Bilateral Otitis Media. He is otherwise healthy and has no history of drug allergies and has previously taken amoxicillin uneventfully. He has been a little more cranky over the last day but otherwise is acting fairly well. He is afebrile and vital signs are normal. What do you think? Any questions?
Click the pic for a larger image.
roseola caused by HHV-6.
ReplyDeleteThis is erythema multiforme, classic target lesions and "multiple shapes of red" This is a drug reaction and not roseola.
ReplyDeletehmmm... definely target lesions. Should have enlarged the photo.
ReplyDeleteOther things in the history help confirm EM vs roseola. 16 month old may have already had roseola.
ReplyDeleteRoseola in usually 2-3 days of fussiness and low to medium fever then rash(finer, fainter than EM) with the rash almost all other symptoms resolve.
The exposure to penicillin for this length of time THEN the rash imtigate for EM. EM may appear even days after drug exposure(sulfa common cause also).
Erythema Multiforme was my diagnosis as well. I am not certain that the antibiotic is the definite cause, my sources state that viral, bacterial, fungal, or protozoal infections can also cause this.
ReplyDeleteWhat else would you look for that can't be seen on the pics? What about the course and treatment of this disease if uncomplicated?
Well here is a term I don't recall hearing before, Giant Urticaria which is what the pediatrician I sent the child to called it.
ReplyDeleteI stand my (correct dx--EM) giant urticaria as I glean from e-msdicine is angioedema. I didn't get the history (and doubt the pt had)of ITCHING. Having had "giant urticaria" myself, it and all other forms of urticaria ITCH like no other itch you have ever had. IF this is the dx then the pt needs steroids and at risk for a severe anaphylactic reaction on re-exposure to the offending agent.
ReplyDeleteThe case you presented is ERYTHMA MUTIFORME!!
A man with a knife wants to cut!
ReplyDeletepath report: acute inflammation with signs of inflammation acutely.
hmmm does the term "giant urticaria" mean that there are also micro urticarias or midget urticarias that lurk out there?
ReplyDelete