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Teenage boy with bullous rash
  1. McKenna Elizabeth Boyd1,
  2. Shabana Yusuf2
  1. 1 Office of Student Affairs, Baylor College of Medicine, Houston, Texas, USA
  2. 2 Pediatrics, Baylor College of Medicine, Houston, Texas, USA
  1. Correspondence to Dr Shabana Yusuf, Pediatrics, Baylor College of Medicine, Houston, TX 77030-3411, USA; syusuf{at}


­A 14-year-old boy with recent antibiotic treatment for tonsillitis, presented to the emergency department with 1-week history of worsening rash and haemorrhagic bullae involving the bilateral legs, trunk and hands (figures 1 and 2). Laboratory results were significant for proteinuria (2+protein) and haematuria (1+, 5–10 red blood cells/high power field); 24 hours urinary protein and renal function were within normal limits. The patient had an inconclusive skin biopsy.

Figure 1

Left and right images show palpable purpura with some overlying bullae and vesiculation coalescing into plaques on both lower extremities.

Figure 2

Left image shows rash on abdominal wall and right image shows coalesced haemorrhagic bullae on hands.


  1. What is the most probable diagnosis?

    1. Bullous Ig A vasculitis

    2. Meningococcemia

    3. Bullous impetigo

    4. Eosinophilic granulomatosis with polyangiitis

    5. Cryoglobulinemia

  2. What is the best test which will establish the diagnosis in this patient?

    1. Renal ultrasound

    2. Renal biopsy

    3. Abdominal ultrasound

    4. Creatinine clearance

  3. What is first line of treatment in this patient?

    1. Antibiotics

    2. Steroids

    3. Surgical debridement

    4. Multispecialty consultation

    5. Immunosuppressants such as azothioprine

  4. What other systems can this condition affect besides the skin?

    1. Lungs

    2. Kidneys

    3. Spleen

    4. Nervous system

    5. A, B and D

Questions Answers can be found on page 02.

  • general paediatrics
  • dermatology
  • immunology
  • rheumatology
  • nephrology

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  • Contributors Both SY and MEB have contributed to this article.

  • Funding All funding for this study was provided by Section of Pediatric Emergency Medicine, Baylor College of Medicine and the Texas Children's Hospital.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.