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• W205770358 abstract "1. Stephanie Eng, MD*2. Amanda Moon, MD†3. Christopher Leander, MD‡4. Michael Del Vecchio, MD§ 1. *Class of 2012, Temple University School of Medicine, Philadelphia, PA; currently affiliated with A. I. duPont Hospital for Children, Wilmington, DE.2. †Dermatology Resident, PGY2, University of Rochester, Strong Memorial Hospital, Rochester, NY.3. ‡Pediatrician, Esperanza Health Center, Philadelphia, PA.4. §Associate Professor of Pediatrics, Temple University School of Medicine, St. Christopher’s Hospital for Children, Philadelphia, PA.A 9-year-old boy presents to the emergency department in mid-April complaining of subjective fevers for 5 days and a rash for 2 days. The rash had appeared initially on his ankles. The day before, the rash had spread to his feet and began to itch. On the day of presentation, the patient is noted to have a temperature of 102°F. His past history is unremarkable and includes removal of a chalazion. He has no history of exposure to anyone with similar symptoms or any recent travel history or time spent in wooded areas. His twin sister had acquired Rocky Mountain spotted fever 1 year ago.On presentation, the boy is alert, oriented, and in no acute distress. Vital signs are temperature, 37.3°C; blood pressure, 94/62 mm Hg; heart rate, 100 beats per minute; respirations, 20 breaths per minute; and oxygen saturation, 99% on room air.Physical examination reveals petechiae on his right hand, left palm, and both knees. No bruising is noted. There are ∼6 petechiae on his chest, and a coalescing petechial rash is present on the dorsal and pedal surfaces of both feet extending to the ankles (Fig).Figure. Petechialrash on feet and ankles.Initial laboratory values include C-reactive protein level of 1.29 mg/L (normal, 0–5 mg/L), hemoglobin concentration of 11.4 g/dL, and hematocrit level of 32.6%. The patient is leukopenic (white blood cell count, 2.8 × 103/μL) and …" @default.
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• W205770358 date "2012-10-01" @default.
• W205770358 modified "2023-09-26" @default.
• W205770358 title "Visual Diagnosis: Fever and Petechial Rash in a 9-year-old Boy" @default.
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• W205770358 doi "https://doi.org/10.1542/pir.33-10-e69" @default.
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