Case 2: Hemolacria, Hematochezia, and Hematuria in an 11-month-old Boy

Giovanna Manzano; Rohini Shantharam; Elke Webb; Nika Finelt; Kyle Hengel

doi:10.1542/pir.2016-0155

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Giovanna Manzano, MD*
Rohini Shantharam, MD^†
Elke Webb, MD^‡
Nika Finelt, MD^†
Kyle Hengel, MD^‡

^*Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
^†Department of Dermatology, Northwell Health, New Hyde Park, NY
^‡Department of Pediatrics, Cohen Children’s Medical Center at Northwell Health, New Hyde Park, NY

AUTHOR DISCLOSURE
Drs Manzano, Shantharam, Webb, Finelt, and Hengel have disclosed no financial relationships relevant to this article. Dr Manzano’s current affiliation is Massachusetts General Hospital, Boston, MA. Dr Webb’s current affiliation is Community Health Services, Hartford, CT. Dr Hengel’s current affilaition is Maimonides Children’s Hospital, Brooklyn, NY. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

Presentation

A previously healthy 11-month-old boy born at full-term presents with a rash for 3 days. It began as a single purpuric lesion on his right ear and progressed over 2 days to involve his face (Fig 1) and all extremities. On the day of presentation, mom reports swelling of his face, hands, and feet; nasal congestion; cough; bilateral conjunctivitis; and “red tears.” He has poor oral intake and urine output, worsening fussiness, is difficult to console, but has no tactile fever. Two weeks ago he completed 10 days of amoxicillin for acute otitis media. His medical, surgical, travel, allergic, and family histories are otherwise unremarkable. His vaccines are up to date. He takes no prescribed or over-the-counter medications.

Figure 1.

Characteristic targetoid lesions present on the patient's left ear and face.

On physical examination he is crying and appears uncomfortable. He is afebrile, and tachycardic to 158 beats/min with normal blood …