Case Studies

A previously healthy, 16-year-old Hispanic boy initially presents to the clinic with a 5-day history of tactile fevers, achy malaise, congestion, and a dry cough. He was afebrile with negative rapid strep and monospot tests, but was prescribed fluticasone, benzonatate, and ibuprofen for a presumed upper respiratory infection. He was encouraged to return if symptoms did not improve.

The anxious parents of a previously healthy 19-month-old boy bring the child to the emergency department for evaluation of progressive rash that began 4 months ago. The skin eruption began as small blisters on his knees, which became tense and ruptured, eventually evolving to red-pink scaly plaques. Over the next few months, the boy developed similar lesions on his hands, elbows, neck, perineal area, and face, with sparing of the mucous membranes.

Two siblings, 5-year-old Emmanuel and 3-year-old Cassandra, are brought to your emergency department (ED) in July 2014 by their parents. Both children are up to date on their immunizations and have not had significant medical problems in the past. They were referred to you by their pediatrician for 1 day of high fevers, rash, and pain in the extremities. Emmanuel had 1 episode of gum bleeding last night. His sister has been unwilling to walk since this morning.

A 9-month-old girl is brought to the emergency department for evaluation after 3 days of poor feeding and 1 day of decreased activity. The day prior to presentation, she was no longer crawling or pulling herself to stand. On the morning of evaluation, she is no longer able to lift her head.

A 9-year-old girl presented with these lesions on her face and extremities. The lesions, which had developed within the past 24 hours, were warm to the touch and only mildly pruritic. The child feels unwell with nonspecific complaints of malaise and lack of energy. Before this eruption, she had been healthy and had not been taking any medications.