Case history A healthy 15-month-old girl presented to the emergency department with a 24-hour history of fever and rash. The initial blanching rash developed into non-blanching areas with associated leg swelling. She had received no recent medications, had no known drug allergies and no unwell contacts.
On examination, she was feverish at 38.6°C, capillary refill time was <2 s with warm peripheries, heart rate 169 bpm and blood pressure 94/59 mm Hg. A palpable purpuric rash was evident on all four limbs and face (figure 1) although the trunk was spared. Her legs were tense and oedematous to the knee.
Haemoglobin level: 131 g/L, white cell count: 16.6×109/L, neutrophils: 11.1×109/L and platelets: 407×109/L
Coagulation screen: normal
C reactive protein level: 20 mg/L
Lactate level: 1.7 mmol/L
Intravenous ceftriaxone was commenced following blood culture and meningococcal PCR. The following day, while remaining systemically well, she developed a vesicular rash on her trunk and back (figure 2).
What is the diagnosis?
Henoch-Schonlein purpura (HSP)
Acute haemorrhagic oedema of infancy (AHOI)
What further investigation is required?
Check viral serology including Epstein-Barr virus and hepatitis B virus
Complement levels and autoimmune screen
Lumbar puncture and audiology
No further investigation
How should this child be managed?
Complete 7 days of ceftriaxone treatment
Regular follow-up with urinalysis and blood pressure monitoring
Stop antibiotics if cultures were negative at 48 hours and discharge
Answers are on page▪▪
- General Paediatrics
Statistics from Altmetric.com
Contributors LS, SMcV and RL contributed equally to the authorship. TB was the supervising consultant.
Competing interests None.
Patient consent Parental/guardian consent obtained.
Provenance and peer review Not commissioned; externally peer reviewed.
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.