ERYSIPELAS
Definition
• Infection caused most commonly by group A Strep
History
• Any age but > in children <3 yr
Physical Findings
• Red/hot tender area of skin, pus/d/c at entry site, ±fevers
Treatment
• Penicillin G, dicloxacillin
Disposition
• Home
VIRAL EXANTHEM
Definition
• Diffuse rash caused by nonpolio enteroviruses (coxsackievirus, echovirus, enterovirus) & respiratory viruses (adenovirus, parainfluenza virus, influenza, RSV)
History
• Any age, recent viral illness
Physical Findings
• Diffuse blanchable erythematous macules on trunk & extremities
Treatment
• Supportive
Disposition
• Home
HAND-FOOT-AND-MOUTH DISEASE
Definition
• Caused by coxsackievirus B
History
• Summer/fall, 1–4 y/o
Physical Findings
• Ulcerative oral lesions on soft palate, macular → pustular → crusted lesions on palms/soles, resolves in 5–6 d
Treatment
• Supportive
Disposition
• Home
IMPETIGO
Definition
• Secondary infection in pts w/ underlying dermatoses caused by S. aureus & group A Strep
History
• Warm humid summer months, any age
Physical Findings
• Papule/vesicle → golden crusted lesions commonly around mouth & on cheeks
Treatment
• Topical abx (2% mupirocin, dicloxacillin, 1st-generation cephalosporins, azithromycin)
Disposition
• Home
KAWASAKI DISEASE
Definition
• Systemic vasculitis of microvessels of unknown etiology, often self-limited
History
• Febrile illness, peak onset 18–24 mo, usually in children <5 yr of age
Physical Findings
• To make the Dx, requires unexplained fever × 5 d + 4 of the following:
• Edema/desquamation of extremities
• Bulbar conjunctivitis
• Polymorphous rash
• Cervical LAD
• Mucous membrane changes (ie, strawberry tongue)
Evaluation
• CBC (↑ WBC, ↑ PLT), ↑ LFTs, thrombocytosis, ↑ ESR, ↑ CRP, sterile pyuria, ECG, echocardiography, RUQ U/S
Treatment
• High-dose ASA 100 mg/kg/d divided into 4 doses
• IVIG 2 g/kg infused over 8–12 h single dose (reduces risk of coronary artery aneurysms from 25–50%)
Disposition
• Admit
Complications
• Coronary artery aneurysm, CHF, MI, dysrhythmias, valvular insufficiency, gallbladder hydrops, uveitis
SERUM SICKNESS
Definition
• Immune-complex mediated type III hypersensitivity rxn
History
• Any age but > in children <3 yr, fever, arthralgias, rash, possible etiologies include blood products, antitoxins (ie, spider or snake envenomations), clostridial infections, meds
Physical Findings
• LAD, rash
Treatment
• Supportive as dz is self-limited, resolves in 2–3 wk, discontinue offending agent
• Short course of corticosteroids can be used for severe arthralgias
Disposition
• Home
HENOCH–SCHÖNLEIN PURPURA
Definition
• Small-vessel vasculitis
History
• Age 2–11 yr; preceding respiratory infection (Group A β-hemolytic Strep); fever, arthralgia, abdominal pain, bloody stools, hematuria
Physical Findings
• Palpable purpura in dependent regions, fever, joint swelling, guaiac positive, scrotal edema
Diagnosis
• Clinical; CBC (↑ WBC, ↑ PLT, anemia), ↑ ESR, antistreptolysin antibodies (+ in 50%), UA (hematuria, proteinuria, pyuria), abdominal U/S (intussusception), scrotal U/S
Treatment
• Majority is self-limiting w/ resolution in a few weeks; supportive, NSAIDs, remove offending agent, treat underlying infection
• Corticosteroids does not prevent recurrences, which occur in 50%; but can be used for severe arthritis, renal involvement, GI, scrotal or CNS cx
Disposition
• Home unless cx: HTN, oliguria, obstruction, intussusception, GIB
Complications
• Bowel obstruction, perforation, intussusception, renal failure, hypertensive encephalopathy, acute scrotum (mimics torsion), CNS cx (sz, coma, neuro deficits)