Step 2

Pediatrics 3

A five-year-old girl is brought to the pediatrician by her parents for concern about a rash on her legs and buttocks which began yesterday and has been progressive. The child also reports abdominal pain. Her parents also report that the child had three episodes of bloody diarrhea 3 days ago. Past medical history is unremarkable, and she does not take any medications. She is afebrile, and the remainder of the vital signs are within normal limits. On physical examination, she is noted to have palpable purpura on both lower extremities. Abdominal examination reveals diffuse tenderness to palpation that does not localize; there is some voluntary guarding. The left knee is noted to be swollen and diffusely tender to palpation. White blood cell count, hemoglobin, platelet count, prothrombin time, partial thromboplastin time, and liver function tests are all normal. A urinalysis reveals mild proteinuria and 5-10 red blood cells per high powered field.

Which of the following is the most likely diagnosis?

  • A) Erythema infectiosus (fifth disease)
  • B) Hemolytic uremic syndrome
  • C) IgA vasculitis
  • D) Kawasaki disease
  • E) Thrombotic thrombocytopenic purpura

Authors

Dr. Ted O'Connell

Editor

Dr. Ted O'Connell

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