?pediatric Case Report.
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Female calm?pediatric Case Report.
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Female calmPediatric case report
History
Lein Ahmed Almasabi ,female 1 month and 8 days old , Saudi
from Najran .
Source of history from her mother.
Chief compliant : skin exfoliating/ 6 days.
The Patient she will until 6 days when her skin started to be diffuse
erythematous rash affecting almost the entire body specially the
back, neck ,axilla , and inguinal folds. Red to brown color with
uid lled blisters .
No reliving or exacerbated factors , not related to certain type of
milk or external factors. Associated with mild fever ( 38C ) relive by
antipyretic simultaneously with the skin exfoliating , irritability and
poor feeding .
Systemic review:
There’s no eye discharge , contact with infectious patients or recent
traveling.
No runny nose , cough , noisy breathing or hemoptysis .
No breathlessness, sweaty on feeding or cyanosis.
No nausea, vomiting, abdominal pain, Jaundice, constipation or
diarrhea.
No hematuria .
No ts or abnormal movements.
No pallor , Jaundice, bruises , joints swellings or bleeding from
body ori ce.
Past medical history:
No similar condition , previous diseases or hospitalization.
Also there’s no surgical or medical signi cant history and not
known to be allergic to certain medication or food .
Pregnancy and neonatal history:
Mother age at pregnancy 24 years old regular antenatal care and
supplementation ( folic acid - iron ) , pass smoothly without
complications, expose to radiation or used of chronic diseases
medications.
Natal : Full term, Weight Of The Baby Was 2.7 Kg , The Baby Cry
Immediately , delivered by cesarean section due to breach
presentation.
Postnatal: discharge after 3 days without complications.
Nutritional history:
She is on exclusive breastfeeding 8-10 time per day.
Immunization:
update she received the rst dose at birth.
Developmental history:
The head is at in prone , visually xed on an object , alert to
sound and she can smile.
Family history:
No family history of similar condition or chronic and inherited
diseases.
Age of the father is 30 years old, the mother 24 years old with
positive consanguinity .
She is the rst baby in family , no history of neonatal death or
abortion .
Social history:
Good house condition, the mother she is educated housewife, the
father educated soldier .
No special habits , contact with animals or recent travailing.
📍 Summary:
47 days old Saudi female complaint of generalized skin
exfoliating / 6 days ago, all over the body specially back, neck,
axilla and inguinal region associated with fever , malaise , and poor
feeding. No similar condition , no surgical or medical signi cant
history.
Examination
General examination:
The patient she look ill , conscious , average body built , laying at
no dysmorphic feature , connected to IV line in the right hand and
ID band in the left hand .
No sing of respiratory distress .
Her skin look erythematous with exfoliating red to brown color in
all the body and uid lled blusters specially the back,
neck ,axilla , and inguinal folds and top layer of skin begins peeling
off in sheets, leaving exposed a moist, red and tender area.
Vital signs:
- Heart rate 160 beat/ min, regular rhythm , average volume , No
Radio-Radial , Radio-Brachial & Radio-Femoral Delay.
- Respiratory rate 34 breath/ min.
- Temperature 37.3 C.
- Oxygen saturation 99%.
- Capillary re ll normal.
Growth parameters:
- Wight : 3 kg. Length : 52 cm.
- Head circumference: 37 cm.
mouth 3kg
mouth 52cm
mouth39cm
mouth snagisaem
Hands:
No clubbing ,splinter hemorrhage, peripheral cyanosis .
No muscle wasting , palmar erythema , or pallor in palmar
creases .
Head and neck :
- eye :no Jaundice , pallor or peri orbital edema.
- nose : no discharge .
- Mouth: no peripheral cyanosis in lips or central on the tongue ,
jaundice or ulcers.
- Neck: there’s skin exfoliating and blusters, no lymph nodes
enlargement.
- Lower limb : skin exfoliating and pigmentation specially in
inguinal region.
Cardio - Pulmonary examination:
- inspection :
symmetrical chest shape no bulging or deformities , surgical scar or
visible pulsation. type of breathing abdominal-Thoracic not using
the accessory muscle
- Palpation:
Cardiovascular: Normal apex beat position in the 5th intercostal
space mid clavicular .
No thrill or para sternal heave.
Respiratory:Normal trachea position , chest expansion .
- Percussion ( Respiratory):
Resonant sounds all over the chest front and back.
- Auscultation :
Cardiovascular : normal S1 , S2 no added sounds or murmurs.
Respiratory: Good air entry , broncho vesicular breathing , no
added sounds.
GIT examination:
- Inspection :
Normal abdominal contour full ank move with respiration .
There is Skin exfoliating in all the abdomen with red to brown
pigmentations .
No Scars , Epigastric Pulsation , Or Dilated Veins.
Normal umbilicus.
- palpation :
Super cial: no Hotness , Tenderness , Rigidity & Super cial
Masses .
Deep : no organomegally .
- percussion : Normal.
Investigations
Laboratory Studies
- CBC ,White blood count (WBC) is normal.
- Erythrocyte sedimentation rate (ESR) is elevated.
- Electrolytes and renal function is normal
- Blood culture is negative
Imaging Studies
A chest x ray normal to rule out pneumonia as the original focus of
infection .
Treatment & Management
Admission to pediatric ward .
Keep non by oral for 8 hours and follow up and start the following:
Fluid rehydration:
Ds 1/2 in Normal Saline 200 ml / 8 hours.
2 meq Kcl / 100 ml
Paracetamol IV.
Parenteral antibiotics:
ceftriaxone 90 mg / IV.
cloxacillin 100 mg / 6 hours IV
Topical skin care :
Fusicid acid ointment / 0.1 % hydrocortisone cream.
Discharge
The patient discharge after 5 days from admission , stable and the
skin exfoliating start healing and become less erythematous
discharge medication :
- fusidic acid ointment
- 0.1 % hydrocortisone cream
- Fenistil Drops (Dimetindene maleate) 0.5 ml PO
Differential Diagnoses
• Staphylococcal Scalded Skin Syndrome
• Exfoliative Dermatitis
• Allergic Contact Dermatitis
• Chemical Burn
• Erysipelas
• Erythema Multiforme
• Hydro uoric Acid Burns
• Impetigo
• Pemphigus Foliaceus
• Physical Child Abuse
• Scarlet Fever
• Stevens-Johnson Syndrome
• Toxic Epidermal Necrolysis (TEN)
• Toxic Shock Syndrome