Unusual Rash Development in a 7-Year-Old Male

CPT. Katherine D. Percy, Lt. Col. Massimo D. Federico, Larry B. Mellick

Department of Emergency Medicine, Carl R. Darnall Army Medical Center, 36000 Darnall Loop, Fort Hood, TX 76544, USAUnited States
Department of Emergency Medicine, Augusta University, Health Sciences Campus, AF-1020, 1120 15

DOI: https://doi.org/10.17140/emoj-3-133 · Published 2017-02-17 · Licence: https://creativecommons.org/licenses/by/4.0 · © 2017 The Author(s)

Also available as PDF (figures and tables appear in the PDF).

ISSN 2379-4046 http://dx.doi.org/10.17140/EMOJ-3-133 Open Journal Case Report Unusual Rash Development in a 7-Year-Old * *Corresponding author Male CPT. Katherine D. Percy, DO Department of Emergency Medicine Carl R. Darnall Army Medical Center 36000 Darnall Loop, Fort Hood 1* 1 2 CPT. Katherine D. Percy, DO ; Lt. Col. Massimo D. Federico, MD ; Larry B. Mellick, MD TX 76544, USA E-mail: katepercydo@gmail.com 1Department of Emergency Medicine, Carl R. Darnall Army Medical Center, 36000 Darnall Loop, Fort Hood, TX 76544, USA Volume 3 : Issue 1 2 Department of Emergency Medicine, Augusta University, Health Sciences Campus, AF-1020, Article Ref. #: 1000EMOJ3133 th 1120 15 Street, Augusta, Georgia 30912, USA Article History th Received: December 9th, 2016 CHIEF COMPLAINT th Accepted: February 16th, 2017 th Published: February 17th, 2017 Redness and swelling to left leg.

HISTORY OF PRESENT ILLNESS Citation Percy KD, Federico MD, Mel- An otherwise healthy 7-year-old male presented to the emergency department complaining of lick LB. Unusual rash develop- ment in a 7-year-old male. Emerg a pruritic, red rash with that had increased in area over 7 days. The rash reportedly began as Med Open J. 2017; 3(1): 14-15. a localized lesion on his left lower extremity and developed a secondary diffuse rash over the doi: 10.17140/EMOJ-3-133 trunk and upper extremities after the initial ED encounter. During the initial emergency depart- ment visit he was prescribed diphenhydramine and topical hydrocortisone with minimal relief. He denied any known environmental or allergen exposures orasthma history suggesting atopic dermatitis, or new exposures to medications. The patient and his parent also denied fever, lymphadenopathy, or any respiratory signs and symptoms. The leg lesion was not indurated or fluctuant to suggest underlying abscess. There were no other ill contacts or family history of similar rashes.

PERTINENT PHYSICAL EXAMINATION The patient was well appearing, well developed and well nourished with no acute distress. He had no signs of anaphylaxis with normal cardiac, lung, and abdominal exams. An eczematous erythematous fine maculopapular rash was limited to torso and extremities excluding mucous membranes, hands, feet, and groin as seen in the following images. The left lower extremity had a notable round 1 cm crusted plaque with excoriation on an erythematous base. Head, eyes, ears, neck, and throat (HEENT) exam was unremarkable without conjunctivitis, oral lesions, facial swelling, lymphadenopathy or erythema.

Copyright ©2017 Percy KD. This is an open access article distributed under the Creative Commons Attribution 4.0 International License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Open Journal ISSN 2379-4046 http://dx.doi.org/10.17140/EMOJ-3-133

CONFLICTS OF INTEREST 2. What is the treatment of this condition?

The authors declare that they have no conflicts of interest.

ANSWERS CONSENT 1. The rash on patient in this photograph represents a case of Written informed consent was obtained from the patient who id Reaction. This is a type IV hypersensitivity reaction that participated in this case.

results in a generalized, acute skin rash developing as a re- sponse to an underlying infectious agentor inflammatory skin

References

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4. The antihistamine and topical corticosteroid treatment previ-York, NY, USA: McGraw-Hill; 2011. ously prescribed to the patient are both indicated for symptomatic relief; however, eradicating the inciting source is the only way to rid the body of an id reaction. The time to resolutionvaries, depending on the underlying etiology. For this patient, mupirocin cream and oral cephalexin were necessary to clear the impetigo, allowing the id reaction to resolve subsequently. One should consider systemic corticosteroids for extensive, severe, or refractory cases. A dermatology consultation for follow-up is also warranted