Rheuma Case: 14-year-old Girl with Abdominal Pain and Rash

00:00 Alright, solved that case, let's move on to case #2. So this is a 14-year-old girl, much younger patient, with no significant past medical history who is presenting with abdominal pain and another rash. Her father reports that she had strep throat 3 weeks ago and was treated with amoxicillin at that time for about 10 days. One week into taking the amoxicillin, she notes a rash developing on both of her legs which they thought perhaps appropriately that it was due to the amoxicillin. But the rash progressed and yesterday she also began complaining of diffuse abdominal pain. Her sore throat resolved. She reports some nausea, no vomiting, no diarrhea, no hematochezia, no fevers, no chills, no lightheadedness so really just the nausea. Review of systems reveals a mild bilateral knee pain and ankle pain, no eye pain or no other eye symptoms, no pulmonary symptoms, no dysuria. Otherwise, she is a highschool freshman, no toxic habits, and her family history is non-contributory. Alright, going to the physical exam, she's got a low-grade temp perhaps 99.4. Vital signs otherwise pretty boring, you could see that her left and right blood pressures are the same. Guess we'll figure out what that means later. No scleral involvement. No lymphadenopathy. Oropharynx is clear. No carotid bruits. Cardiopulmonary exam is also benign. Her abdomen reveals a soft, mildly distended abdomen. It's diffusely tender to moderate palpation. And her guaiac of her stool is positive. Neurologically, no findings.

01:41 Musculoskeletal exam, she has painful range of motion of both of her knees and ankles but there is no objective evidence of warmth though on effusion. And on her skin exam, yet again, we're finding palpable purpura this time with some petechiae symmetrically distributed on both legs and feet mostly on the posterior surfaces. And I guess we've got an image here. No pustules.

02:05 Again, lots of data. This is a characteristic feature of vasculitis. If you find yourself with lots of systems involved, lots of physical exam findings, and lots of findings lighting up on your data, you should really be thinking about vasculitis right off the bat. Alright, so which of the following is the most likely diagnosis? Alright, another long list of names. Let's start with Kawasaki's disease. By way of reminder, this is a multisystem, acute vasculitis that definitely affects children so let's take a look at this one first.