TY - JOUR T1 - Teenage boy with bullous rash JF - Archives of disease in childhood - Education & practice edition JO - Arch Dis Child Educ Pract Ed DO - 10.1136/archdischild-2019-317600 SP - edpract-2019-317600 AU - McKenna Elizabeth Boyd AU - Shabana Yusuf Y1 - 2020/06/23 UR - http://ep.bmj.com/content/early/2020/06/23/archdischild-2019-317600.abstract N2 - ­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.QuestionsWhat is the most probable diagnosis?Bullous Ig A vasculitisMeningococcemiaBullous impetigoEosinophilic granulomatosis with polyangiitisCryoglobulinemiaWhat is the best test which will establish the diagnosis in this patient?Renal ultrasoundRenal biopsyAbdominal ultrasoundCreatinine clearanceWhat is first line of treatment in this patient?AntibioticsSteroidsSurgical debridementMultispecialty consultationImmunosuppressants such as azothioprineWhat other systems can this condition affect besides the skin?LungsKidneysSpleenNervous systemA, B and DQuestionsAnswers can be found on page 02. ER -