Elliott Hampton

Elliott Hampton
Elliott Hampton

Saturday, July 21, 2012

I hate rash week.

Here's a riddle for all of you that are epidemiology junkies:
6/25- Elliott is given the following vaccines: HepA, MMR, Prevnar 13, VAR (Varicella)
7/3- Elliott has a fever of 102.5, lethargic, fussy. CBC indicates likely viral infection.
7/5- Elliott has a red, pin prick- like flat rash on his trunk and genitals that spread to entire body within hours. Fever of 100.6.
7/7- Rash and fever are gone.
7/11- E has diarrhea with awful diaper burn and is fussy buns (as one would expect).
7/12- Diarrhea continues, now with fever. See new pedi. Diagnoses him with gastroenteritis.
7/14- Fever gone, diaper burn gone, no more big D.
7/17- Elliott slept all day. Very irregular. No fever.
7/18- Fever returns, lethargic, Rash- begins as tiny pin prick- like raised dots on lower abdomen and groin. Within hours, it had spread to chest, back and upper thighs. Pedi examines him and gives diagnosis of Enterovirus.
7/19- Fever spikes to 103F. Rash worsens. Dots are now raised and all over body, including face.
7/20- Fever continues to run 102. Drops to 99.5-100 with Tylenol. Back to pedi. Blood work indicates: Elevated hemoglobin and hematocrit, elevated white blood count, normal electrolytes. Blood culture to be completed by morning. Pedi noted blood work corroborates enterovirus. suggested Benedryl for rash, continue Tylenol.
7/21- E is miserable and rash worsens. He is refusing liquids, and solids (hasn't eaten much in terms of solids for weeks- during all of these bouts). Here are pictures of the rash:

You can really see the topography in the below picture. I should also note that the rash does turn white upon pressure.

Is this really just part of enterovirus? It looks nothing like examples I have seen of enteroviral rashes. It looks a lot like measles. Reactions to MMR are typically within 14 days, but can occur up to 28 days following the vaccine. Is it typical to have 2 separate reactions to MMR? His symptoms are:
-Fever (now down to 99-100)
-Discomfort, picking and scratching at rash
-seemingly sore throat- red and irritated on exam
-refusal to eat or drink (has had maybe 12 oz of fluids-water, formula, Gatorade G2- since midnight)
He doesn't have any other symptoms. Respiratory rate is fine, Heart rate is in 120s (fine), no diarrhea during this particular spell.
Any ideas?

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