The Season of Rashes

By: Molly Kelly, OMS-IV

1.) A 6 year old boy is brought to your office by his mother who states that the patient has been experiencing fevers of 101.3F and complaining of abdominal pain and vomiting for the past several hours. She also notes that the patient has developed an unusual rash on his legs and has been complaining of pain in his knees and ankles. Upon further review of his history, you learn the boy had a mild cold that resolved last week. Your physical exam reveals a reddish-purple palpable rash on his legs and buttocks and swelling of his knees and ankles with restriction in motion. What immunoglobulin is responsible for this child’s presentation?

2.) A 52 year old woman comes to the office for her annual wellness exam. She complains she is getting old when she attempts to stand up from a chair in the waiting room and finds herself needing to use her arms to push herself up out of the chair. She also complains about her new hair-do as she had to cut her hair shorter because she found it increasingly difficult to brush her hair in the morning. She states that it has been taking forever for her to get ready in the morning because of “getting old” and proudly shows off her new violet colored eyeshadow she says has developed naturally. Upon exam, you discover an erythematous rash in a V-like distribution on her shoulders and back. You also notice scaly erythematous eruptions or red patches overlying the knuckles as pictured below. What does this woman have?

3.) A 13 year old boy is brought to his pediatrician with complaints of a fever, headache, sore throat and a painful rash. The rash is versicular in appearance and localized to his palms and soles. In getting a throat culture, the you notice the patient has ulcers in his mouth and on his tongue. What is responsible for this patient’s illness?


ANSWERS:

1. Immunoglobulin A (IgA) and Complement component 3 (C3)
This boy has Henoch-Schonlein purpura (HSP or anaphylactoid purpura) is a form of blood vessel inflammation or vasculitis in which complexes of immunoglobulin A (IgA) and complement component 3 (C3) are deposited in the small arterial vessels in the skin, gastrointestinal tract and frequently the kidneys. HSP results in a skin rash, most prominent over the buttocks and behind the lower extremities associated with joint inflammation (arthritis), and cramping pain in the abdomen.
2. Dermatomyositis
This woman is not feeling her age because she has dermatomyositis, a connective-tissue disease related to polymyositis that is characterized by inflammation of the muscles and the skin. While dermatomyositis most frequently affects the skin and muscles, it is a systemic disorder that may also affect the joints, the esophagus, the lungs, and, less commonly, the heart. The main symptoms include skin rash and symmetric proximal muscle weakness which may be accompanied by pain. The heliotropic or “lilac” rash is a violaceous eruption on the upper eyelids, the shawl (or V-) sign is a diffuse, flat, erythematous lesion over the back and shoulders which worsens with UV light. The lesions seen on her hands are known as Grotton’s papules.
3. Coxsackie A Virus
Hand-foot-and-mouth disease (HFMD) is a moderately contagious viral illness most commonly caused by coxsackie A virus, a member of the picornaviridae family. This illness is characterized by fever, sores in the mouth, and a rash on the hands and feet with blisters. It mostly affects children younger than 10 years of age, but people of any age can be infected. HFMD is not to be confused with foot-and-mouth disease, also called hoof-and-mouth disease, which is a separate disease affecting sheep, cattle, and swine. Both diseases are caused by members of the picornaviridae family, but are not trans-communicable between humans and livestock.