Pediatrics in Review
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(Pediatrics in Review. 2000;21:321-323. doi:10.1542/10.1542/pir.21-9-321)
© 2000 American Academy of Pediatrics
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A Febrile Infant Who Has Hand Edema and Erythema


Joseph A. Zenel, MD*
* Editor, Visual Diagnosis.

   Presentation
 
A 10-month-old boy was brought to the emergency department with a 36-hour history of progressive warmth, redness, and swelling of the left hand and, in the preceding few hours, refusal to move the fingers of that hand. For the past 24 hours, he had a persistent fever. One week ago, he had a brief bout of vomiting and diarrhea. For several days, his parents have noted rhinorrhea, occasional fever, and poor appetite, but no other symptoms.

The child had been healthy previously and had received his primary immunization series for diphtheria, tetanus, pertussis, polio, Haemophilus influenzae type b, and hepatitis B. His parents have not administered any medication other than acetaminophen and ibuprofen for the fever. They denied any trauma to the hand or exposure to any animals.

Physical examination revealed an irritable but consolable infant who held his left arm in flexion with his fingers partially flexed (Fig. 1Go ). He had a temperature of 40.7°C (105.3°F), respiratory rate of 32 breaths/min, pulse of 170 beats/min, and blood pressure of 124/76 mm Hg. The left hand was swollen from the fingers to 1 cm proximal to the wrist. The dorsum of the left hand was red, warm, and tender, with no clear distinction between the red and the normal skin. The infant cried during passive flexion and extension of the left fingers, but gave no evidence of pain on active and passive movement of the left wrist. No blisters were noted on the hand. Findings on examination of the head, ears, eyes, nose, and throat were normal. Tears and moist mucous membranes were present. Auscultation of the chest demonstrated bilateral clear breath sounds and normal S1 and S2 heart sounds without a murmur. Abdominal, genitourinary, . . . [Full Text of this Article]


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