Non Blanching Rash Differential Diagnosis

fever, non-blanching rash Temporal arteritis •Unilateral throbbing pain •Scalp tenderness and jaw claudication •>55 years •May be visual problems Subarachnoid haemorrhage •Very sudden onset severe headache •"like some on hit me with a brick over the head" •Meningismus Raised intracranial pressure (e. Rashes in Children can be divided into 'blanching' and 'non-blanching'. Solar purpura (also called actinic purpura, or Bateman purpura) is a common form of non-inflammatory purpura. Viral URTI Cough, rhinorrhoea, but no respiratory distress. The diagnosis of drug rash with eosinophilia and systemic symptoms (DRESS) should be ruled out in patients with a high fever, or with facial edema or lymphadenopathy. Livedo reticularis is a common skin finding consisting of a mottled reticulated vascular pattern that appears as a lace-like purplish discoloration of the skin. Conclusions: This case highlights the importance of recognizing the clinical exam finding of retiform purpura as this will guide the differential diagnosis of a patient with sepsis and a rash. The rash begins as a red raised lesion and then changes to the typical targetoid appearance, with a purplish colour. Rocky Mountain spotted fever, a tick-borne rickettsial illness, presents with some type of rash in 90% of cases. The associated symptoms and signs help identify patients with a serious disorder and often suggest the diagnosis (see Table: Some Causes of Rash in Infants and Children). According to the morphology the rashes are classified usually to five (or more) groups. Thus, the pediatrician frequently encounters a diagnostic dilemma between timely diagnosis of sepsis and unnecessary invasive diagnostics. A previously healthy 13 year old boy comes into your office complaining of headache, muscle pain, and a rash consisting of numerous non-blanching macules on his palms, forearms, wrists, and ankles, which are spreading to his chest and back. Children commonly present with a non-blanching rash. Case presentation A 10-year-old boy presents to the emergency department of his local hospital with a purpuric rash of sudden onset on his buttocks and legs (Figures 1a and b). 55% of those who did not have meningococcal disease had petechiae beyond the distribution of the superior vena cava, attributed by the authors to vasculitis or disordered coagulation secondary. Description: A rash without a known cause that can be a round or oval, pink, and scaly with a raised border. The differential diagnosis of PPD also includes hyperglobulinemic purpura, purpuric clothing dermatitis, stasis pigmentation, scurvy, leukocytoclastic vasculitis, and drug hypersensitivity reactions. Can you identify the mechanism of injury? A patient presents to the emergency department with this injury. However, it is very important to learn the proper technique for the different sections of the exam to be 100% confident about the presence or absence of any findings. A fever and a non-blanching rash can be an early sign of a life-threatening infection known as meningococcal disease. Viral URTI Cough, rhinorrhoea, but no respiratory distress. Skin hemorrhaging, hematuria, and epistaxis occurred in patients with the hemorrhagic form of scarlet fever. Blood extravasation into dermal layers –> Purpura –> Non-blanching. Rick, Mike, and Miz discuss the differential of non-blanching rashes and the sometimes-difficult diagnosis of Henoch Schonlein Purpura. It is the most common vasculitis in children. You might have had rashes on your arms or legs, or even your face. NON BLANCHING erythematous patch, Rash + fever + child unwell – Its meningococcaemia RCH guidelines – Administer ceftriaxone (50mg/kg, max 2g) or cefotaxime (50mg/kg, max 2g). Examination of her torso and extremities revealed non-blanching, violaceous-to-brown papules and plaques of varying sizes. Biopsy of the rash demonstrated superficial and mid-dermal perivascular and interstitial infiltrate comprised mainly of neutrophils and nuclear dust of neutrophils, along with fibrin present in the walls of some venules and multiple extravasated red blood cells. Study Differential Diagnosis using smart web & mobile flashcards created by top students, teachers, and professors. However, most (> Retrieve Content. Differential diagnosis is broad and includes infections, autoimmune, malignancy, metabolic, drug/toxin-induced, neurologic, and congenital etiologies. Use the glass test to identify the meningitis rash which does not fade under pressure and is a sign of meningococcal septicaemia. The rash continued to fade over the next 2-3 days. AIMS To examine a number of simple clinical features and investigations in children with a non-blanching rash to see which predict meningococcal infection. All 4 of the SLE patients with rashes demonstrated prominent facial eruptions in a malar dis-tribution, while 2 also had non-blanching, purpuric lesions on the hands and upper and lower extremities. Petechiae and target lesions may be present as well Arthritis (82%): The ankles and knees are most frequently affected; however, the elbows, hands and feet may also be involved. Normal HEENT exam with no oral ulcers or scleral injection. DA: 46 PA: 50 MOZ Rank: 41. Diagnosis of the poisoned patient can often be accomplished before toxicologic laboratory tests by obtaining a detailed history and directed physical exam. Case presentation A 10-year-old boy presents to the emergency department of his local hospital with a purpuric rash of sudden onset on his buttocks and legs (Figures 1a and b). If the petechiae appear in clusters, then they resemble a rash on the legs. blanching, non-tender rash on his lower extremities with rough feel; and oozing crusts in his nose bilaterally Negative Findinqs: No oral lesions, no eye abnormalities, or neurologic abnormalities. [uspharmacist. Cutaneous Vasculitis — More Than Skin Deep. Livedo reticularis is a common skin finding consisting of a mottled reticulated vascular pattern that appears as a lace-like purplish discoloration of the skin. Purpura: non-blanching, erythematous macules or papules due to extravasation of red blood cells into dermis. Table 1 shows the results of initial labora-tory testing at our facility, as well as those from a recent presentation at his local hospital. The primary differential diagnoses to consider for any rash presenting in childhood are viral exanthems, inflammatory dermatoses, local bacterial or fungal/parasitic infections, tick-borne disease, drug eruptions, systemic bacterial infections, anaphylactic reactions, haematological disorders, and vasculitic/rheumatological conditions. Diagnostic Considerations. It is wise to develop a systematic approach to rashes in the ED, one that helps you recognize the deadly causes of rash while narrowing the differential diagnosis. Rashes in Children can be divided into 'blanching' and 'non-blanching'. Bleeding tendency - known or clinically suspected. A high Anti-Mitochondrial Antibody (AMA) titer supports the diagnosis of primary biliary cirrhosis (PBC). Differential diagnosis. One model notes six, broad morphologic categories of dermatologic life threats. Rash is non-blanching, non-vesicular and symmetric. Unlike uncomplicated viral illnesses, the child is usually quite unwell several days into the illness when the rash appears. blanching erythematous macules on the trunk and proximal extremities. Fever and Petechiae Flowchart. The differential diagnoses for RMSF are numerous and include viral illness, drug reaction, meningococcemia, leptospirosis, Lyme disease, measles, and idiopathic thrombocytopenia purpura. Differential diagnoses. You should inspect the skin carefully for distribution of petechiae and purpura and other types of rashes—especially for lesions below the nipple line, any elevation and non-blanching of lesions. On the day of birth, the skin of this baby had a very leathery appearance. Stephen Paget presents the case of a 24-year-old woman with fever, extremity swelling, and a fleeting rash. What body sites are involved? 2. METHODS A total of 233 infants and children up to 15 years of age presenting with a non-blanching rash were studied over a period of 12 months. Physical examination was significant for a widely split second heart sound with an ejection systolic murmur in the left upper sternal border. Widespread wheeze or crackles. The author discusses a case of drug induced vasculitis caused by spironolactone which is very rare complication of the drug. The incubation period varies with the organism causing the infection. The petechial rash typically begins on the wrists and ankles but may be found anywhere, including the oral mucosa, as in this child. They are typically admitted for fever and a non blanching rash and no other specific findings. This sign of meningococcal sepsis has been the subject of public health campaigns to help parents recognise its importance and seek urgent medical attention (fig 1 ⇓ ). 2) Papules: Solid, raised hemispherical lesions that are tiny and blanch on pressure. It is a characteristic of both purpuric and petechial rashes. Most summer skin rashes are not harmful and will disappear by themselves after a few days. On physical examination, there is a non-blanching rash predominantly on the legs but extending to the lower back. Doctors give trusted, helpful answers on causes, diagnosis, symptoms, treatment, and more: Dr. Petechiae are pinpoint, round spots that appear on the skin as a result of bleeding. WebMD Symptom Checker helps you find the most common medical conditions indicated by the symptoms joint pain and skin rash including Lyme disease, Osteoarthritis, and Tendinitis. Influence of a non-blanching rash in the diagnosis of meningococcal disease Source: BestBETS - 06 February 2007 BestBets: Influence of a non-blanching rash in the diagnosis of meningococcal disease. Differential diagnosis Conditions to include in the differential diagnosis for a child of this age include the following. Neonatal cutaneous eruption differential diagnosis is challenging because multiple conditions may play a causative role in the pathogenesis of a cutaneous rash in a neonate such as congenital infections, hemolytic disease, twin-twin transfusion syndrome, fetomaternal hemorrhage, intracranial bleeding, and neoplastic,. Support your list with medical knowledge & exam skills of rheumatic disease learned in the previous lecture. Individual purpura measure 3–10 mm (0. Purpura is a non-blanching spot that measures greater than 2 mm. The rash begins as a red raised lesion and then changes to the typical targetoid appearance, with a purplish colour. To ensure that meningococcal disease is considered as a differential diagnosis in children presenting with petechial rash, leading to prompt treatment. Blood tests are often carried out to check for the presence of infection, autoimmune and inflammatory conditions as well as blood abnormalities. DA: 90 PA: 51 MOZ Rank: 52. Blood tests help exclude other diagnoses such as ITP under “fever and non-blanching rash” Order Set. Contact Dermatitis Some kids' skin reacts after touching foods, soaps, or plants like poison ivy, sumac, or oak. Travel-related causes of Non-blanching vascular lesions List of 3 causes of Non-blanching vascular lesions This section shows a full list of all the diseases and conditions listed as a possible cause of Non-blanching vascular lesions in our database from various sources. Bacterial infections. The differential diagnoses for RMSF are numerous and include viral illness, drug reaction, meningococcemia, leptospirosis, Lyme disease, measles, and idiopathic thrombocytopenia purpura. Non-blanching urticarial wheals, erythematous maculopapules and larger, palpable ecchymosis-like lesions. Symmetry b. Its cause is unknown, but there are two forms—one that affects children (usually between 2-4 years old and commonly after a viral infection) and one that affects adults (usually women). Your age, duration of illness, and other symptoms may suggest which virus is the cause. A previously healthy 13 year old boy comes into your office complaining of headache, muscle pain, and a rash consisting of numerous non-blanching macules on his palms, forearms, wrists, and ankles, which are spreading to his chest and back. Petechiae are lesions the size of a pin-head (different sources say less than 2 mm or 3 mm, others up to 5 mm) and purpura are lesions that are larger than this (and may or may not be palpable). What type of streptococcal infection occurs in pts with a recent splenectomy? 5. When a clear glass is pressed firmly against the skin the rash is still visible. Children commonly present with a non blanching rash +/- fever. Scalp and hair (hair loss or excess hair) The scaly scalp (in addition the scalp may be itchy or sore) Eczema (generalised erythema with fine scale); Seborrhoeic eczema (generalised erythema usually with fine scale, although sometimes the scale can be thick with adherent crusts / from the scalp the rash can spread to the eyebrows, mid-line of the face and behind the ears). Skin biopsy confirmed the diagnosis of mastocytosis. 0 Algorithm 5 References 1. Neonatal cutaneous eruption differential diagnosis is challenging because multiple conditions may play a causative role in the pathogenesis of a cutaneous rash in a neonate such as congenital infections, hemolytic disease, twin-twin transfusion syndrome, fetomaternal hemorrhage, intracranial bleeding, and neoplastic, autoimmune or hematological disorders [1-9]. 1 Gianotti-Crosti syndrome, an important differential in post-infective papular eruptions, is less likely in an adult (most common in young children) in the absence of. Unlike uncomplicated viral illnesses, the child is usually quite unwell several days into the illness when the rash appears. It most commonly affects children. It is wise to develop a systematic approach to rashes in the ED, one that helps you recognize the deadly causes of rash while narrowing the differential diagnosis. A Blueberry-Muffin Baby Melissa Reyes Merin, MD, MPH April Armstrong, MD Thomas Konia, MD Larissa Larsen Clinical Presentation ¥ID: Ð2 day-old newborn delivered by C-section at 41 weeks of gestation due to failure to progress ¥CC: ÐMultiple purple nodules on head, trunk and extremities, but otherwise physical exam normal. Blanching and Non-Blanching Rashes. The petechial rash typically begins on the wrists and ankles but may be found anywhere, including the oral mucosa, as in this child. Decon guidelines final 15 07 Published on Jul 15, 2015 RCPCH publication - Management of children and young people with an acute decrease in conscious level. This article reviews the broad differential diagnosis and pathophysiology of infection-associated hemorrhagic skin lesions. However, the rash can also present in the upper extremities, thorax, and face. Non-blanching, maculo-papular rash with scattered petechiae. Pityriasis rosea rash. A 53 year old, afebrile woman presented to the dermatology clinic with a two week history of petechial rash on her lower extremities that had progressed up to her arms. Subsequent recognition of the clinical exam finding of purpura fulminans led to initiation of treatment with later pathologic confirmation on skin biopsy. ASSESSMENT: Differential Diagnosis (DDx) 1. HSP often develops after an upper respiratory tract infection and is more likely to present in autumn, winter and spring. Bacterial infections. 15 April 2010 GPs need to be familiar with the many types of rashes that can occur in children, says Dr Neha Mistry. Management of the child with a non-blanching rash Children commonly present with a non blanching rash +/- fever. They’ll examine how the skin looks around the blanched area and request your medical. History and neurological examination was of limited value as the patient was sedated; however, the normal CSF analysis ruled out the possibility of meningitis or encephalitis. The petechial and coalescing rash (Figure 1) was non-blanching, mildly tender and palpable. The most concerning alternative diagnosis would be ***. She ambulated with an antalgic gait due to left ankle pain. The important diagnosis to exclude in these patients is meningococcal disease. Acute haemorrhagic oedema of infancy, which occurs in children under the age of 2, is a form of urticarial vasculitis. haemorrhagic). Normal HEENT exam with no oral ulcers or scleral injection. •Systemic symptoms e. Mitochondrial M2 Antibody has an even higher specificity for PBC. Case: Case 26. - Acrocyanosis (gray, non-blanching, lips, ears, nose, fingers, toes; peripheral gangrene - Plague Roseola manifestation: 2 yr old child develops a fever for a few days, rapid defervescence followed by maculopapular rash of trunk and neck, clears in a few days. The rash may involve the palms of the hands and soles of the feet but usually does not involve the face. The red rash (which could lead to purple bruising) is only one of the symptoms of meningitis. Although the differential diagnosis is very broad, adequate history and physical examination can help the clinician narrow down a list of more probable etiologies. Number 14-03: A case of an Inferior Sinus Venosus Atrial Septal Defect diagnosed utilizing multimodality imaging. Diagnosis wide Rx Coamoxiclav, gentamicin Then tazocin/clarithromycin Swinging fever to 40, hypotension to 79/53, MEWS to 10 Increased resp rate and low Sats; malaena x 1 Hb dropped from 145 to 105, albumin to 22, lactate 3 Rash on day 7 of admission (day 12 of illness) Macular rash including palms and soles (non blanching) No eschar. Blanching and Non-Blanching Rashes. Parents report the rashes to be red, brown, black, purple and dark pink. This looks like little Non blanching means that if you press on the rash, the spots don't fade under pressure and return to normal colour once there is no pressure. One can diagnose maculopapular rash by first taking into account past illness or diseases. Purpura is a non-blanching spot that measures greater than 2 mm. Well children with petechiae confined to the area of the distribution of the superior vena cava (SVC) (above the nipple line) are unlikely to have a diagnosis of meningococcal disease Consider investigation and treatment of children who may have received partial treatment with antibiotics. The patient was ill-appearing, disoriented and unable to provide detailed history. The physical exam is crucial for the diagnosis of aortic regurgitation and also for the identification of its causes and possible complications like heart failure. Differential diagnosis of diseases presenting with rash can be broad, and at times challenging [4]. After a regular non-invasive blood pressure cuff was placed on his right arm above the elbow to measure blood pressure, asymptomatic skin rash on the right forearm appeared. Rashes are much more commonly associated with such differential considerations as Neisseria meningitidis meningitis, Rocky Mountain spotted fever, subacute bacterial endocarditis, and viral (eg, echovirus 9) meningoencephalitis than with Haemophilus influenzae type b (Hib) meningitis. WebMD Symptom Checker helps you find the most common medical conditions indicated by the symptoms body aches or pains, decreased appetite, fatigue and fever including Viral syndrome, Mononucleosis, and Gastroenteritis. However, most (> 90%) of these children who are well with the rash will have viral infections that require no treatment. However, the rash can also present in the upper extremities, thorax, and face. Many rashes are itchy, red, painful, and irritated. Meningitis with a non-blanching rash is likely to be meningococcal. Differential Diagnosis. Physical examination revealed numerous small non-blanching erythematous and violaceous macules confined from the elbow to the tips of the digits. rashes—especially for lesions below the nipple line, any elevation and non-blanching of lesions, and sclera icterus. A non-blanching rash (NBR) is a skin rash that does not fade when pressed with, and viewed through, a glass. Patterns? a. Rashes on the palms of your hands can be red or itchy and cause cracks in the skin. This page checks if javascript and session cookies are enabled. Fever • Is the most common childhood presentation to medical professionals • Wide range of differential diagnoses • Diagnosis can be challenging…. Only 2 of the 7 developed a non-blanching rash, leading clinicians to consider IMD as a differential diagnosis (Campbell et al, 2016). Non-blanching lesions: Non-blanching lesions are areas of damaged tissue that do not lose color or fade when pressed. Splinter or subungual haemorrhages : linear and red. Study Paediatric Histories flashcards from Jo Balmforth's University of Manchester class online, or in Brainscape's iPhone or Android app. Support us The Royal Children's Hospital Melbourne. The lesions are dark red and slightly raised. Classifications of Pressure Ulcers - IN. Key Physical Exam Findings - N/V - abdominal pain and tenderness upon palpation ot the RUQ. Macules are not raised or atrophic; clinicians must consider other salient features to assist in developing a reasonable differential diagnosis. a non blanching haemorrhagic rash is a characteristic feature of meningococcal disease (2) the rash may be absent, scanty or it may be blanching in the early stages (especially in pure meningitis) (2) a blanching, maculopapular rash at early stages of the disease may develop into a non blanching rash as the disease progress (from minutes to. Non-blanching rashes can be a great cause for concern for parents and physicians alike. Purpura just means purple. Minor cases may cause mild redness or a rash of small red bumps. Her vital signs are: HR 170 beats/min BP 90/66 mmHg RR 60 /min Temperature 39 °C O 2 Saturation 96 % on room air Cap return 2 sec i. Natural fabrics such as cotton are best. Petechiae (puh-TEE-kee-ee) commonly appear in clusters and may look like a rash. The rash usually starts as small, red pinpricks before spreading quickly and turning into red or purple blotches It doesn't fade if you press the side of a clear glass firmly against the skin If a rash doesn't fade under a glass, it's a sign of blood poisoning (septicaemia) caused by meningitis and you should get medical advice right away. NON BLANCHING erythematous patch, Rash + fever + child unwell – Its meningococcaemia RCH guidelines – Administer ceftriaxone (50mg/kg, max 2g) or cefotaxime (50mg/kg, max 2g). 0 Algorithm 5 References 1. Diagnostic Considerations. feature is the haemorrhagic rash, which is non-blanching and present in around 80 per cent of cases. Early clinical assessment Usual clinical assessment. Pityriasis rosea, a rash that usually appears on the torso, upper arms, thighs or neck, may sound worse than it really is. Joint pain and Skin rash. In most cases, however, a self-limiting viral disease is the underlying cause. net , that alluded to a brief diagnostic algorithm to help guide the dermatologically clueless through the differentiation of skin presentations. His neck was supple with no lymphadenopathy. It must be emphasized that non-infectious diseases with skin rash can also present with fever and should be considered in the differential diagnosis. Classifications of Pressure Ulcers - IN. Analysis; News; Journal scan; Clinical update. Thus, the pediatrician frequently encounters a diagnostic dilemma between timely diagnosis of sepsis and unnecessary invasive diagnostics. 6 g/dL; and platelet count, 237,000/ m L. She reported loss of appetite with 10 pounds weight loss in last 1 month. Coagulation screen, bleeding time, platelet. pneumoniae infections? 6. For some excellent further reading on NON-BLANCHING RASHES, click the link. Rocky Mountain spotted fever. WebMD Symptom Checker helps you find the most common medical conditions indicated by the symptoms joint pain and skin rash including Lyme disease, Osteoarthritis, and Tendinitis. non-blanching rash. History and neurological examination was of limited value as the patient was sedated; however, the normal CSF analysis ruled out the possibility of meningitis or encephalitis. Possible causes include osteoarthritis of the knee, injuries (such as muscle strain and fractures), tumours, referred pain from the hip or lumbosacral spine, and bursitis. 5 The diagnosis can be hard to elucidate as rat bites heal quickly, often absent by the time of presentation1 and seemingly innocuous rat. The physical exam is crucial for the diagnosis of aortic regurgitation and also for the identification of its causes and possible complications like heart failure. Marked edema of the scrotum and anus were noted, no lesions were present at this time. Henoch-Schönlein purpura (HSP) affects the blood vessels and causes a spotty rash. 03:57 The main thing in the differential diagnosis of this rash, there are other things that can do it. Differential Diagnosis Meningococcal Septicaemia or Other Bacterial Sepsis : If there is any possibility of meningococcal septicaemia then a non-blanching rash should be managed as this with immediate antibiotics, as this condition can lead to morbidity / mortality if treatment is delayed. Ask parents about any new rashes or marks on their child's skin. The important diagnosis to exclude in these patients is meningococcal disease. Dermatologic Diagnoses 101: Describing Skin Findings, Formulating a Differential John C. DA: 46 PA: 50 MOZ Rank: 41. Many would suggest a lumbar puncture is unnecessary, 3, 4, 25 but this clinical picture is not always a result of meningococcal disease. Erythematous macules developing into purple, non-blanching, non-pruitic urticarial, palpable pupruic lesions Rarely: haemorrhagic bullae and vesicles which desquamate In <3 year old, subcutaneous oedema of the scalp, ears, periorbital area, dorsi of the hands, feet and genitalia. The meningococcus replicates rapidly in the bloodstream and the rash may evolve very quickly. Possible causes include osteoarthritis of the knee, injuries (such as muscle strain and fractures), tumours, referred pain from the hip or lumbosacral spine, and bursitis. Blueberry muffin rash, hyperbilirubinemia, and hypoglycemia: A case of hemolytic disease of the fetus and newborn due to anti-Kpa Skip to main content Thank you for visiting nature. Bronchiolitis Age 0-12 months. CMR is a useful tool for the differential diagnosis of HCM, as it can differentiate HCM from other mimicking conditions because of its superior spatial resolution and its ability to tissue characterise. Blood tests help exclude other diagnoses such as ITP under “fever and non-blanching rash” Order Set. The differential diagnosis of the rash is wide including Henoch-Schönlein purpura, autoimmune vasculitis, meningococcaemia, gonococcaemia, staphylococcal and streptococcal infections and leptospirosis. At least two patients were isolated in a side-room in A and E because of diarrhoea. Treatment options are summarized in Table I. A 26-year-old woman presents with the above rash. Skin exam revealed multiple punctuate, non-blanching, dark, red and purple papules on his abdomen, hips and fingers. These are non-blanching erythematous (reddish) skin lesions resulting from the extravasation of blood due to intradermal capillary leakage. The authors give account on the type of vasculitis caused by drug induced allergy and also the differential diagnoses if the presentation is unusual with only hematuria and kidney injury. Skin hemorrhaging, hematuria, and epistaxis occurred in patients with the hemorrhagic form of scarlet fever. However, most (> Document Viewer. The rash looks like little red. Petechial rashes are a common presentation to the pediatric emergency department (PED). Purpuric rash can be further differentiated into the size of the lesions, petechiae are pinpoint hemorrhages less than 2mm in diameter, purpura are 2-10mm wide purple flat lesions and purpuric ecchymosis are more than 10mm wide and look like a large bruised area. The guidelines are not meant to replace your clinical judgement. Erythema multiforme is an acute, inflammatory skin condition. Joint pain and Skin rash. Chronic meningococcemia - rare < 2%. Petechial rash in children: a clinical dilemma: Why emergency nurses must be aware of the differential diagnoses associated with petechial rash before initiating treatment for invasive. They have long presented a diagnostic dilemma to paediatricians. Low titers of AMA may be detected in other liver disorders, which include chronic active hepatitis and cryptogenic cirrhosis. fever, non-blanching rash Temporal arteritis •Unilateral throbbing pain •Scalp tenderness and jaw claudication •>55 years •May be visual problems Subarachnoid haemorrhage •Very sudden onset severe headache •"like some on hit me with a brick over the head" •Meningismus Raised intracranial pressure (e. The petechial and coalescing rash (Figure 1) was non-blanching, mildly tender and palpable. Overview At least 90% of children with fever and petechiae will NOT have meningococcal disease. These are non-blanching erythematous (reddish) skin lesions resulting from the extravasation of blood due to intradermal capillary leakage. The clinical differential diagnosis for her rash included a systemic fungal infection, mycobacterial infection, viral exanthem, disseminated leishmaniasis. 55% of those who did not have meningococcal disease had petechiae beyond the distribution of the superior vena cava, attributed by the authors to vasculitis or disordered coagulation secondary. Viral URTI Cough, rhinorrhoea, but no respiratory distress. DA: 70 PA: 67 MOZ Rank: 44. Purpura are characterized by non-blanching skin lesions between 3-10 mm in size that are caused by bleeding into the skin. Breath-holding spells. Larger patches than the one shown here are also common. 4 Upon further questioning, the patient denied joint or sinus symptoms, but recalled a non-blanching, non-. Many types of virus that causes measles and other infectious diseases are responsible for causing this rash. Table 1 summarizes some diagnostic considerations based on the mechanism of petechiae formation. Can you identify the mechanism of injury? A patient presents to the emergency department with this injury. 15 April 2010 GPs need to be familiar with the many types of rashes that can occur in children, says Dr Neha Mistry. The group called 'blanching' disappears when you press it. The group called 'blanching' disappears when you press it. Department of Dermatology The mission of the Department is to be a world leader in the care of skin and patients with skin diseases through outstanding clinical service, education and training, and research. Different descriptive terms based on size are used to describe purpura. A cardinal sign of a purpuric rash is that it does not blanch on pressure, unlike exanthema, telangiectases, or allergic rashes. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Other causes include irritating substances and allergies. Purpura are larger non-blanching spots (>2mm). fever, non-blanching rash Temporal arteritis •Unilateral throbbing pain •Scalp tenderness and jaw claudication •>55 years •May be visual problems Subarachnoid haemorrhage •Very sudden onset severe headache •”like some on hit me with a brick over the head” •Meningismus Raised intracranial pressure (e. However, in many aetiologies these forms may co-exist or evolve from one form to another. It is wise to develop a systematic approach to rashes in the ED, one that helps you recognize the deadly causes of rash while narrowing the differential diagnosis. Scalp and hair (hair loss or excess hair) The scaly scalp (in addition the scalp may be itchy or sore) Eczema (generalised erythema with fine scale); Seborrhoeic eczema (generalised erythema usually with fine scale, although sometimes the scale can be thick with adherent crusts / from the scalp the rash can spread to the eyebrows, mid-line of the face and behind the ears). The important diagnosis to exclude in these patients is meningococcal disease. List of causes of Non-blanching vascular lesions and Petechial rashes in adults, alternative diagnoses, rare causes, misdiagnoses, patient stories, and much more. 0 Algorithm 5 References 1. Classification of rashes non-blanching papules or macules due to extravasation of Characteristic rash that resembles. Blocking a Rash Diagnosis: An Unusual Case of Infective Endocarditis. Other causes include irritating substances and allergies. A wide range of benign and dangerous pathology can present with a rash. DIFFERENTIAL DIAGNOSIS Flare of Still’s disease His daily fevers, evanescent rash, arthritis, hyperferritine-mia, and liver dysfunction were consistent with a flare of Still’s disease (1,2), but his low ESR, thrombocytopenia, and lack of response to steroids were not. During the secondary stage, may have skin rashes and/or sores in mouth, vagina, or anus. DA: 90 PA: 51 MOZ Rank: 52. One can diagnose maculopapular rash by first taking into account past illness or diseases. Causes include: Congenital causes such as: Hereditary haemorrhagic telangiectasia (Osler-Weber-Rendu syndrome). The group called 'non-blanching' doesn't disappear when you press it. Usually flat to the touch, petechiae don't lose color when you press on them. According to the morphology the rashes are classified usually to five (or more) groups. No deterioration in clinical state or progression of the rash over 4 hours; NB. The petechial and coalescing rash (Figure 1) was non-blanching, mildly tender and palpable. List 8 causes of a non-blanching rash 4. The rash usually won't itch and it is sometimes so faint that it is easily missed. A small group may present with classic features of meningitis but no rash and have the diagnosis confirmed at lumber puncture. When a cutaneous vasculitis is suspected, assessment should focus on ruling out vasculitis that is threatening a critical organ, confirming vasculitis diagnosis and identifying an underlying trigger or disease where possible. Later symptoms can include seizures, photophobia and rapid breathing rate. A 53 year old, afebrile woman presented to the dermatology clinic with a two week history of petechial rash on her lower extremities that had progressed up to her arms. glucocorticoids which led to resolution of the rash. A non-blanching spot is one that does not disappear after brief pressure is applied to the area. However, recognition and early treatment of the child with meningococcal disease is paramount. •Systemic symptoms e. Non-blanching rash - Paediatric Clinical Guidelines Management of the child with a non-blanching rash non-blanching rash Children commonly present with a non blanching rash +/- fever. Machtinger on blanching maculopapular rash: Macules are flat. Patterns? a. Learn vocabulary, terms, and more with flashcards, games, and other study tools. The rash may also be urticarial wheals or a maculopapular rash. One can diagnose maculopapular rash by first taking into account past illness or diseases. Hands and feet (dorsum). A skin biopsy may be very helpful. The differential diagnoses for RMSF are numerous and include viral illness, drug reaction, meningococcemia, leptospirosis, Lyme disease, measles, and idiopathic thrombocytopenia purpura. However, most (> 90%) of these children who are well with the rash will have viral infections that require no treatment. Five of the seven teen-agers died. Lichen planus 5. Bacterial meningitis incubation is. This page checks if javascript and session cookies are enabled. Use the glass test to identify the meningitis rash which does not fade under pressure and is a sign of meningococcal septicaemia. Clinicians need to keep a differential diagnosis in mind, particularly in cases that do not respond to antifungal therapy. Prep for a quiz or learn for fun! Differential Diagnosis Flashcards & Quizzes | Brainscape. Those that cause purpuric rashes include meningococcal septicaemia, streptococcal septicaemia and diphtheria. Key Physical Exam Findings - N/V - abdominal pain and tenderness upon palpation ot the RUQ. It most commonly affects children. Why are some rashes non-blanching? To blanch or not to blanch, that is the question. Differential diagnosis in SJS and early TEN include erythema multiforme, viral exanthems, and other drug rashes; Stop all potentially offending medications. In most cases, however, a self-limiting viral disease is the underlying cause. Rash on the lateral aspect of the patient's left ankle.