Pediatric Case Study Rash 1

8-year-old girl had strep pharyngitis, cervical lymphadenopathy, fever and positive Rapid Strep test and was prescribed amoxicillin by Urgent care two days ago. She woke up this morning with numerous red targets like rings all over her back and trunk and arms. The pink rings are clear in the middle and of various sizes. She is not in any respiratory distress but does complain of some itching. She is running a low-grade temp of 100.9.

Additional questions pertinent to diagnoisis:

Do you have any allergies?

Have you ever been prescribed Amoxicillin before? If so have you ever had any reaction to it before?

Did you notice any skin changes prior to this morning when you woke up?

Have the rings gotten bigger or smaller?

Does it hurt at all?

Did the rash all start this morning or has it progressed?

Has it changed or spread since this morning when you got up and noticed it?

You stated it itches, do you notice anything else about the rash? Burning, itching, blistering?

Does anything make it worse or better?

Are you taking any over the counter or prescription creams, lotions, or meds for it?

Is amoxicillin the only current medication your taking?

Did you still take your amoxicillin this AM?

Has anyone else that you’ve been around have a rash?

Do you do any sports? Specifically, anything on mats? Have you been on any mats in hym class?

Developmental questions this visit: I WILL DO THIS, WRITER YOU DO NOT NEED TO DO THESE QUESTIONS I WILL!

Diagnosis???

SJS

Erythema Mulitform (differential diagnosis?)

Contact Derm?????

Stevens-Johnson syndrome SJS (Diagnosis One): Preliminary diagnosis may involve a physical examination of visible signs, or a patient’s medical history (Mayo Clinic, 2018). According to Mayo Clinic (2018), diagnosis of SJS should entail skin biopsy, a test of skin and oral cultures, and imaging. In positive SJS test, infection occurs on less than 10% of the patients’ skin; otherwise, it is considered TEN (Genetics Reference, 2018). A positive Nikolsky’s test indicates the presence of SJS and differentiates it from TEN (Maverakis et al., 2017). Also, a skin biopsy is crucial in establishing SJS (Maverakis et al., 2017). The infection majorly affects the skin and mucous membranes causing erosions and blisters (Mockenhaupt, 2011). Blisters and erosions at an involvement ratio of 3% to 10% of the total body skin, confirm the presence of SJS (Maverakis et al., 2017). Mockenhaupt (2011) identify that SJS causes red targets, blisters, and purpuric spots on the torso. Notably, oral infection may lead to other infections such as the lymph nodes and the throat (Cleveland Clinic, n.d.). Hence, the presence of strep pharyngitis, cervical lymphadenopathy may indicate SJS.

Erythema Mulitforme (Diagnosis two): Erythema Mulitforme is a medical condition that affects the cutaneous tissue, and its causes are unknown. According to Maverakis et al. (2017), diagnosis of Erythema Mulitforme may include physical examination, where 10% involvement is a positive test. However, Mayo Clinic (2018) finds that biopsy is not necessary for the diagnosis of Erythema Mulitforme. Also, targets on the skin and papules distributed in patterns indicate Erythema Mulitforme (Stoopler, Houston, Chmieliauskaite & Sollecito, 2015). They continue to report that differential diagnosis for Erythema Mulitforme entails dermatitis herpetiformis, essential urticaria, and acute febrile neutrophilic. Besides, it is imperative to differentiate Erythema Mulitforme from oral diseases such as herpetic stomatitis and aphthous stomatitis. Often, patients have targets on the skin, and papules distributed in patterns on the trunk and face, and the oral infections affect the torso like SJS (Maverakis et al., 2017). Hence, both Erythema Mulitforme and SJS are prone to mistaken treatment.

References

Cleveland Clinic. When Are Swollen Glands a Sign of Cancer in the Lymph Nodes?. Retrieved 18 January 2020, from https://health.clevelandclinic.org/when-are-swollen-glands-a-sign-of-cancer-in-the-lymph-nodes/

Genetics Reference, G. (2018). Stevens-Johnson syndrome/toxic epidermal necrolysis. Retrieved 18 January 2020, from https://ghr.nlm.nih.gov/condition/stevens-johnson-syndrome-toxic-epidermal-necrolysis

Maverakis, E., Wang, E., Shinkai, K., Mahasirimongkol, S., Margolis, D., & Avigan, M. et al. (2017). Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis Standard Reporting and Evaluation Guidelines. JAMA Dermatology, 153(6), 587. doi: 10.1001/jamadermatol.2017.0160

Mayo Clinic. (2018). Stevens-Johnson syndrome – Diagnosis and treatment – Mayo Clinic. Retrieved 18 January 2020, from https://www.mayoclinic.org/diseases-conditions/stevens-johnson-syndrome/diagnosis-treatment/drc-20355942

Mockenhaupt, M. (2011). The current understanding of Stevens-Johnson syndrome and toxic epidermal necrolysis. Expert Review Of Clinical Immunology, 7(6), 803-815. doi: 10.1586/eci.11.66

Stoopler, E., Houston, A., Chmieliauskaite, M., & Sollecito, T. (2015). Erythema Multiforme. The Journal Of Emergency Medicine, 49(6), e197-e198. doi: 10.1016/j.jemermed.2015.06.018

Stoopler, E., Houston, A., Chmieliauskaite, M., & Sollecito, T. (2015). Erythema Multiforme. The Journal Of Emergency Medicine, 49(6), e197-e198. doi: 10.1016/j.jemermed.2015.06.018