Childhood Rashes That Present To The ED Part I: Viral And Bacterial Issues

Lampell, Marc S. MD
Mace, Sharon MD
Whiteman, Paula J. MD

²University of Rochester School of Medicine and Dentistry, Assistant Professor of Emergency Medicine, Assistant Professor of Pediatrics
⁴Associate Professor, Emergency Department, Ohio State University School of Medicine, Director of Pediatric Education And Quality Improvement and Director of Observation Unit, Cleveland Clinic, Faculty, MetroHealth Medical Center, Emergency Medicine Residency
⁵Medical Director, Pediatric Emergency Medicine, Encino-Tarzana Regional Medical Center; Attending Physician, Cedars-Sinai Medical Center, Los Angeles, CA

Date of original release: March 1, 2007.

Date of most recent review: February 1, 2007.

See “Physician CME Information” on back page.

Pediatric Emergency Medicine Practice 4(3):p 1-22, March 2007.

You're managing to keep your head above water during the evening shift in the pediatric emergency department of a university hospital when you get a phone call from a local physician who's sending you a dilemma that she's been struggling with for three days. The case is a four-year-old girl who recently moved from Russia (unknown vaccination status) with persistent fever over 40°C for three days. The child is “toxic” appearing and has impressive coryza and a non-productive cough. Her eyes are very red with scant non-purulent discharge for which the pediatrician prescribed antibiotic drops. The child developed a rather impressive non-pruritic facial rash that rapidly spread to the trunk. Despite a negative “rapid strep” test and blood and urine cultures, the pediatrician's concern for this “toxic” kid was sufficiently worrisome that she elected to start antibiotics. In the pediatric ED, the child is noted to be normotensive, but is tachycardic (consistent with her febrile state). The exam confirmed the report by the pediatrician and found nonexudative pharyngitis and pustules on the buccal mucosa opposite the molars. A serologic test was sent that confirmed the suspicion of the attending on duty.