I should precede this by noting that rashes are one of the most common reasons I see pediatric patients in the urgent care. Sore throats are hands down the most common reason, followed by asthma-related issues… but rashes are well up there, probably more common than lacerations or other trauma. What nobody ever put in the Official Parents’ Manual, however, is just how common rashes are in kids. Kids practically develop a rash if you even look at them wrong. The vast majority of pediatric rashes are due to a viral cold, eczema, strep, minor trauma, or other transitory cause that is of little long-term danger, which makes it very tempting for the physician to blow off yet another pediatric rash, no matter how experienced and well-trained they are.
A 7 year old Hispanic male presented with, well, a rash. The rash involved all four extremities at the further ends (what we call “distal”). The mother stated that the rash started in the palms of the hands and soles of the feet, before spreading up his wrists and ankles. The rash involved irregular red spots, ranging from tiny dots to irregular shapes no more than 1 cm diameter. The spots were blanching, meaning they turned white when pressed with a finger. The child thought one or two might have been vaguely itchy; he was not sure. Mother stated that he had tactile fevers and body aches about 3 days prior to presentation; the rash appeared 1-2 days ago. He had no other issues such as cough, sneezing, headache, trouble breathing, pain, sore throat, trouble with vision. He had no past medical history of other problems, and he took no medications. The mother denied any new foods, laundry detergents, soaps, animals in the house, or other known new exposures. The child did not have a rash anywhere else, including inside his mouth. Thee mother stated that they had stayed at a religious camp in a rural area, near a forest in a mid-Atlantic state, about one and a half weeks ago. Exam was normal besides the rash discussed above. Mother and child could not recall any insect bites. They could not recall any other recent rashes.
I left the room and did some online research to confirm my suspicions, after which:
AT THIS POINT I WAS 100% SURE OF THE DIAGNOSIS. WHAT IS YOUR GUESS?