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Make the diagnosis.


A 4-year-old male with a history of asthma presents with a 10-day history of cough, wheezing, rhinorrhea, and fever. He was treated with ibuprofen and albuterol without much improvement. Two days prior to presentation, he developed swollen and cracked lips as well as pink conjunctiva (see photo).

Since then, he has been hypoactive with poor oral intake. He was evaluated by his pediatrician and was given dexamethasone and diphenhydramine, with no improvement. His oral and ocular symptoms worsen, which is why he was taken to the emergency department. He has no sick contacts. On the day of presentation, he developed several target erythematous lesions on his arms and legs that progressed to bulla (see photo).

Physical exam

On exam, the patient was febrile and dehydrated. On skin exam, he has erythematous, crusted, hemorrhagic erosions on the upper and lower lips. There is a grayish white membrane on the buccal mucosa bilaterally, and bilateral conjunctival injection. Shotty (small nodes that feel like buckshot under the skin) cervical lymphadenopathy is present.

All four extremities have several erythematous papules with a targetoid appearance; some are bullous. The palms and soles are spared. The patient has a persistent cough, but no wheezing on auscultation, and breath sounds are normal.

What is your diagnosis?

A. Stevens-Johnson syndrome caused by ibuprofen.

B. Erythema multiforme major from herpes virus.

C. Mycoplasma pneumoniae-induced rash and mucositis.

D. Kawasaki disease.

E. Herpetic gingivostomatitis.


Please note: Illustration(s) are not available due to copyright restrictions.

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Publication:Pediatric News
Geographic Code:1USA
Date:Dec 1, 2015
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