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📌 Gastritis:

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Paracentesis

#Clinical_case 29

An 8-year old girl has been brought to the hospital with a complaint of generalized skin manifestations. The young girl was taken to a local clinic on an outpatient basis about 10 days ago following a sore throat and fever.
The physician diagnosed her with a cold and started Amoxicillin for her. 3 days after start taking amoxicillin, she developed skin rashes that started on the head and face that spread to the chest and abdomen after a few hours that was accompanied by lip swelling and dyspnea. Following a quick visit to a hospital, hydrocortisone and clindamycin was prescribed for her.
During hospitalization, swelling of the lips and dyspnea improved, but skin rashes spread to the back and buttocks.

📌 Physical examinations:

Neck 👉 Small 1*1cm lymph node on the lateral side of the neck

Pharynx 👉 Erythema and brief hypertrophy of the tonsils without exudate

Skin 👉
Palpable purpura, generalized on the skin that faded with pressure but doesnt disappeared completely.

(See the pictures below)

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1⃣ Differential diagnosis?

2⃣ Required laboratory tests?

3⃣ Management?

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📌 Thoracentesis
📌 Pleural tapping

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📌 Asthma treatment

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✅ Management of GI Bleeding


📌 Check ABC
📌 Cardiac monitoring and P.O
📌 Oxygen supplement therapy
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#Clinical_case_answer 29

1⃣ Differential diagnosis:

1) Drug eruption
2) Infectious mononucleosis
3) Serum sickness
4) Scarlet fever
5) SJS
6) Kawasaki disease
7) Angioedema
8) Vasculitis
9) Exanthematous pustulosis
10) DRESS syndrome

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2⃣ Required lab tests:

📌 CBC diff
📌 ESR, CRP
📌 Liver function tests
📌 Peripheral blood smear
📌 PCR-covid19
📌 Heterophile Ab
📌 Throat smear

🔔 Discussion:

Clinical manifestations such as palpable purpura, angioedema, lymphadenopathy and generalized skin rashes are suggesting drug sensitivity reaction. For definite diagnosis, we need to follow patients symptoms and its progrssion, while we take a look on lab results. Complete blood cell count with differential (looking for eosinophilia, which supports the diagnosis and also occurs in patients with drug rash with eosinophilia and systemic symptoms [DRESS]), neutrophilia, as in acute generalized exanthematous pustulosis (AGEP), or to identify cytopenias.Liver and kidney function tests (looking for systemic involvement which may occur in patients with DRESS or Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN).

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3⃣ Management:

1) Drug withdrawal
2) Symptomatic treatment e.g,

📌 Oral diphenhydramine 25-50mg q4-6h

📌 Oral hydrocortisone 25mg q8h

📌 Oral citerizine 10mg daily

⚠️ We suggest not routinely using systemic corticosteroids for the treatment of uncomplicated exanthematous drug eruptions. However, in patients with drug-induced rash and systemic or cutaneous symptoms suggesting a severe cutaneous reaction, a short course of moderate/high-dose systemic corticosteroids (eg, prednisone 1 to 2 mg/kg per day for five to seven days) may be beneficial.

4) Patient education:

During the acute phase of the drug reaction, patients should be educated about warning signs of more severe hypersensitivity reactions. These include:

📌 high fever
📌 facial edema
📌 mucosal symptoms
📌 skin tenderness
📌 blistering.

This patient got better gradually just with prescription of oral diphenhydramine without any corticosteroid.

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✅ Final diagnosis:

#Drug_eruption