10-19-2008, 02:12 AM
A mother brings her 5-year-old boy to the clinic because of a rash on his legs and buttocks that she
noticed this morning. He has also been complaining that his "belly hurts," but has had no change in
appetite. He had an upper respiratory tract infection and sore throat about 1 week ago. He has not had
any fevers, recent weight loss or joint pain, and has not taken any medications. His temperature is 37.0
C (98.6 F). Physical examination shows mild periumbilical tenderness and multiple 3-6 mm raised
erythematous lesions on his lower extremities and buttocks. The lesions do not blanch with pressure.
His leukocyte count, hemoglobin, platelet count, and coagulation studies are normal. Urinalysis shows
3-5 RBCs per hpf. A rapid strep test is positive. The most likely diagnosis is
A. Henoch-Schönlein purpura
B. Idiopathic thrombocytopenic purpura
C. Kawasaki disease
D. Rocky Mountain spotted fever
E. Wiskott-Aldrich syndrome
noticed this morning. He has also been complaining that his "belly hurts," but has had no change in
appetite. He had an upper respiratory tract infection and sore throat about 1 week ago. He has not had
any fevers, recent weight loss or joint pain, and has not taken any medications. His temperature is 37.0
C (98.6 F). Physical examination shows mild periumbilical tenderness and multiple 3-6 mm raised
erythematous lesions on his lower extremities and buttocks. The lesions do not blanch with pressure.
His leukocyte count, hemoglobin, platelet count, and coagulation studies are normal. Urinalysis shows
3-5 RBCs per hpf. A rapid strep test is positive. The most likely diagnosis is
A. Henoch-Schönlein purpura
B. Idiopathic thrombocytopenic purpura
C. Kawasaki disease
D. Rocky Mountain spotted fever
E. Wiskott-Aldrich syndrome