A previously healthy 8-year-old female presents to the pediatric emergency department due to a rash. Her symptoms started three days prior to presentation with a painful rash on her lower extremities. The rash subsequently spread to the buttocks and upper extremities, and she developed intermittent diffuse abdominal pain, a nonproductive cough, and pharyngitis. The patient denies subjective fever. Known sick contacts include the patient’s mother, who tested positive for COVID-19 two and a half weeks prior.
Vitals: T 98.5°F; HR 93; BP 115/68; RR 16; O2 sat 100% on room air Constitutional: Well-developed and in no acute distress HEENT: Normocephalic, atraumatic; moist mucus membranes; no conjunctival injection; posterior pharyngeal erythema without exudates; tonsils are three bilaterally; lips are not cracked; no “strawberry tongue”; Neck: Normal range of motion; no lymphadenopathy Cardiovascular: Regular rate and rhythm; normal heart sounds and pulses Pulmonary: Effort is normal; normal breath sounds; no wheezing Abdominal: Abdomen is flat; minimal tenderness to palpation without guarding; no organomegaly Skin: Diffuse petechial rash and painful, palpable, nonblanching purpura in the dependent regions (most notable on the buttocks and lower extremities)
COVID-19: Detected Complete blood count (CBC): WBC 10K, hemoglobin 13, platelets 469 Comprehensive metabolic panel (CMP): Na 138, K 4.1, Cl 103, CO2 26, BUN 7, Cr 0.38, Glucose 94, ALT 23, AST 26, Albumin 4.5 Lipase: 10 Urinalysis (UA): Normal C-reactive protein (CRP): 3.4 Erythrocyte sedimentation rate (ESR): 24 Procalcitonin: 0.03 Fibrinogen: 363 BNP: <10 Troponin: 0.00 Ferritin: 83 Triglycerides: 37
Immunoglobulin A (IgA) Vasculitis. This patient presented with palpable purpura and petechiae without the presence of thrombocytopenia, as well as diffuse abdominal pain. The majority of cases of IgA Vasculitis are preceded by a respiratory pathogen, with the most common being streptococcus, staphylococcus, and parainfluenza virus. Although not well-documented due to its recent conception, COVID-19 is likely to be the cause of this patient’s vasculitis. Usual management of IgA Vasculitis is supportive care, with admission and specialty referral for complications including intussusception and glomerular involvement. Given the severity of the differential diagnoses, this patient was admitted to the hospital for observation and discharged the following day with close follow-up
Images and cases from the Society of Academic Emergency Medicine (SAEM) Clinical Images Exhibit at the 2021 SAEM Annual Meeting | Copyrighted by SAEM 2021 – all rights reserved. View other cases from this Clinical Image Series on ALiEM.
Take-Home Points
Copyright
Author information
Kate Alemann, MD
Resident Physician
Department of Emergency Medicine
Saint Louis University
The post SAEM Clinical Image Series: Pediatric Rash appeared first on ALiEM.