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Question: Rash

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A 6yo girl presents with palpable purpura of both legs for 2 days. She has not had any fever and is well appearing. Her labs, including CBC, electrolytes, BUN, Creatinine, and ESR are normal. She does not complain of any pain. Her vital signs are temperature 37.5 C, HR 90, RR 20, BP 90/45. She has no abdominal tenderness, vomiting, respiratory difficulty, joint pain or swelling, and her urination has been normal. Her stool guaiac is negative.

What is the best disposition for this patient?

pemsou5_wp • September 4, 2018

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  1. Kelly September 4, 2018 - 10:05 am Reply

    D) Discharge with close follow-up with pediatrician and subspecialist (nephrologist). The patient has a rash typical of Henoch-Schonlein purpura. The normal platelet count on CBC rules out thrombocytopenia. IVIG or Rhogam is used to treat ITP (immune thrombocytopenia). The patient is well appearing and afebrile and petechiae are not described, so meningococcemia or another infectious cause is unlikely. The patient needs to be followed closely and a nephrologist can be consulted, but inpatient monitoring is not needed. Indications for admission with HSP include: severe abdominal pain (intussusception may occur), significant GI bleeding, altered mental status, severe arthritis, renal insufficiency (elevated creatinine), hypertension, poor urine output, nephrotic syndrome.

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