Unusual Rash Development in a 7-Year-Old Male
An otherwise healthy 7-year-old male presented to the emergency department complaining of
a pruritic, red rash with that had increased in area over 7 days.
The rash reportedly began as a localized lesion on his left lower extremity and developed
a secondary diffuse rash over the trunk and upper extremities after the initial ED encounter.
During the initial emergency department visit he was prescribed diphenhydramine
and topical hydrocortisone with minimal relief.
He denied any known environmental or allergen exposures or asthma 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.
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.
The antihistamine and topical corticosteroid treatment previously 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 resolution varies, 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.
Emerg Med Open J. 2017; 3(1): 14-15 doi: 10.17140/EMOJ-3-133
