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Visual Diagnosis: Teenager with Fever, Petechiae, Confusion, and Weakness

Senthil Velan Bhoopalan, Rupesh Kumar Natarajan and David Di John
Pediatrics in Review January 2019, 40 (1) e1-e6; DOI: https://doi.org/10.1542/pir.2017-0108
Senthil Velan Bhoopalan
*Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN
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Rupesh Kumar Natarajan
†Department of Pediatrics, University of Nevada School of Medicine, Las Vegas, NV
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David Di John
†Department of Pediatrics, University of Nevada School of Medicine, Las Vegas, NV
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  1. Senthil Velan Bhoopalan, MD, PhD*
  2. Rupesh Kumar Natarajan, MD†
  3. David Di John, MD†
  1. *Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN
  2. †Department of Pediatrics, University of Nevada School of Medicine, Las Vegas, NV
  • AUTHOR DISCLOSURE

    Drs Bhoopalan and Natarajan have disclosed no financial relationships relevant to this article. Dr Di John has disclosed that he is principal investigator for AstraZeneca and Cempra Pharmaceuticals clinical trials research on new drugs to treat infections in children, and he is on the speaker's bureau for vaccine-related issues for Sanofi Pasteur. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

Presentation

A 13-year-old previously healthy girl presents with fever (101.5°F [38.6°C]) for 3 days. It was preceded by generalized headache. The patient reports no history of vomiting, difficulty breathing, coughing, chest pain, blurry vision, speech disturbance, or trauma. The patient also has diffuse muscle pain, although no swelling of limbs or limitation of activity is reported. There is no history of any recent travel, sick contacts, or exposure to animals or insects. She does not report any intravenous drug abuse. Her dental braces were adjusted 2 weeks before admission. Our patient has no previous medical or surgical history. There is no family history of any congenital heart defects, arrhythmia, or frequent infections. She lives with her parents and has a 31-year-old brother, who is healthy.

In the emergency department she has a temperature of 102°F (38.9°C), with associated tachycardia but otherwise normal vital signs. Her physical examination shows an ill-appearing young febrile girl who is alert and oriented to time, place, and person but has trouble recalling events that happened in the past 5 to 7 days. Strikingly, there are multiple nonblanching petechial hemorrhages in the tips of her fingers and toes (Figs 1–3). In addition, tender nodes are appreciated in both palms and soles. The patient also has some weakness of all 4 limbs, but no other notable findings on clinical examination are appreciated. Importantly, auscultation of the heart …

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Pediatrics in Review: 40 (1)
Pediatrics in Review
Vol. 40, Issue 1
1 Jan 2019
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Visual Diagnosis: Teenager with Fever, Petechiae, Confusion, and Weakness
Senthil Velan Bhoopalan, Rupesh Kumar Natarajan, David Di John
Pediatrics in Review Jan 2019, 40 (1) e1-e6; DOI: 10.1542/pir.2017-0108

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Visual Diagnosis: Teenager with Fever, Petechiae, Confusion, and Weakness
Senthil Velan Bhoopalan, Rupesh Kumar Natarajan, David Di John
Pediatrics in Review Jan 2019, 40 (1) e1-e6; DOI: 10.1542/pir.2017-0108
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More in this TOC Section

  • Visual Diagnosis: Rash and Fatigue in a 6-year-old Girl
  • Visual Diagnosis: Petechiae, Gingival Hyperplasia, Metaphyseal Lucencies, and Refusal to Ambulate in a 5-year-old Boy
  • Visual Diagnosis: Tension Pneumothorax with Evolving Cysts in an Infant
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