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What is that rash?
  1. Lynne Speirs,
  2. Steven McVea,
  3. Rebecca Little,
  4. Thomas Bourke
  1. Royal Belfast Hospital for Sick Children, Belfast, UK
  1. Correspondence to Dr Lynne Speirs, Royal Belfast Hospital for Sick Children, 180–184 Falls Road, Belfast BT12 6BE, UK;

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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.

Figure 1

Rash at presentation.

Initial investigations:

  • 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 …

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