Sepsis Due to Superinfected Varicella? A Case of a Challenging Rash
[摘要] A 6-year-old boy with no significant medical history and up-to-date immunizations presented to the emergency department (ED) with diffuse rash, leg swelling, and respiratory distress. Five days before presentation, the patient twisted his ankle while playing soccer and developed mild swelling. The following day he developed a fever and was brought to his pediatrician; he was diagnosed with an ankle sprain and a viral illness and was managed with ibuprofen and supportive care. On the day of presentation, he developed a vesicular rash that started on his forehead and spread over his entire body. In the ED, he was febrile (temperature: 102°F), tachypneic (respiratory rate: 42 breaths per minute), tachycardic (heart rate: 155 beats per minute), hypotensive (80/50 mm Hg), and lethargic. His physical examination was notable for a tense and swollen lower left leg from 2 cm below the knee to the dorsum of the foot, with decreased but palpable pulses. He also had diffuse 2- to 4-mm pink, umbilicated vesicles involving his face, trunk, and extremities (Figs 1 and 2). Although inconsistent with the patient’s history, these lesions raised concern for varicella.FIGURE 1 Umbilicated vesicles on the abdomen.FIGURE 2 Crusted vesicles on the face.In the ED, the patient was started on intravenous ampicillin-sulbactam and vancomycin because of his toxic appearance and the presence of skin lesions. Chest radiography revealed reticulonodular densities throughout the lungs bilaterally as well as small bilateral pleural effusions. Results of admission laboratory tests were pertinent for a complete blood cell count with depressed cell lines and elevated inflammatory markers. His white blood cell count was 1.2 K/μL, hemoglobin was 9.2 g/dL, and platelets were 36 K/μL. His C-reactive protein level was 24.5 mg/dL, and creatine kinase was 349 U/L. Results of coagulation studies were within normal limits, but fibrinogen and d-dimer levels were elevated (738 …
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[效力级别] [学科分类] 儿科学
[关键词] Campylobacter;proljev;dob [时效性]