PROBLEM SOLVING IN CLINICAL PRACTICE
Where have all the neutrophils gone?
1 Department of Paediatric Infectious Diseases, St Mary’s Hospital, London, UK
2 Department of Paediatric Haematology, St Mary’s Hospital London, UK
3 Department of Immunology, St Mary’s Hospital, London, UK
4 Department of Paediatric Immunology, Great Ormond Street Hospital, London, UK
Correspondence to:
Dr Sanjay Patel, Department of Paediatric Infectious Diseases, St Mary’s Hospital, Praed Street, London W2 1NY, UK; sanjay.patel@ich.ucl.ac.uk
| The first 150 words of the full text of this article appear below. |
An 8-week-old boy presented with a history of fever associated with an ulcerating rash over both hips that had worsened over the preceding 5 days (fig 1). He was the first child of non-consanguineous West African parents, the pregnancy having been uneventful. His mother was known to be HbSC trait and had no history of previous miscarriages or infant deaths. The child was delivered in good condition by emergency lower segment caesarean section for failure to progress with a birth weight of 3.69 kg. At presentation he was thriving along the 50th centile. He had received the BCG vaccine in the neonatal period but had not received any further vaccines. He had also had a pustular groin rash that had developed at 4 weeks of age and had spontaneously resolved.
Figure 1 Photograph of the skin rash overlying the left hip.
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The patient was empirically started on iv flucloxacillin and
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