Case presentation
Dr venkateshsodisetty
MD pediatrics
Name : Jatan
Age 9 years
Sex. Male
Admission date 27-06-2024
Discharge date 01 -07-2024
Cheif complaints :Fever since 10 days
Rashes since 6 days
Swelling of face since 3 days
Reduced oral inake and activity since 1 day
Hopi : 9 years old male child, developmentally normal came with chief complaints of fever
since 10 days
Onsent of fever: since 16th June
Severity : low grade fever (100 degree f)
On and off , 2 to 3 spikes every day
Afebrile from 21 to 25th of June
Fever started again from 26th June
Rashes since 6 days
Started on day 4 of illness
Generalized,
Raised erythematous lesions
Shape: round
Size: different sizes
associated with itching
Blanch with pressure
Mild swelling on face since 3 days
More on eyelids
Present thought the day , not progressive
No h/o hurried breathing
No h/o change in voice
No h/o abdominal pain/ vomiting/ loose stools /joint swelling/blisters
Past h/o : no similar complaints in the past
Immunization h/o : upto date
Treatment H/o :child was admitted in local hospital for 6 days - febrile illness /Acute urticaria
20days back child diagnosed with UTI , received iv ceftriaxone for 5 days , followed by syp septran
Family h/o: nothing significant
Personal h/o: no h/o nebulization in past.
No h/o skinRashes in childhood
General examination
Apperance sick looking
Skin : rashes all over the body
Temp: 100.3 F
Vary in Size and Shape, Blanch with
Hr: 130 Pressure,
RR: 27cycles /min Facial swelling present
Pulse: low volume Lip swelling is present
Cold peripherals No lympadenopathy
Bp 80/57mm of hg ( less than 5th centile)
Spo2: 98 on room air
systemic examination :
R/S : b/l air entry equal
No added sounds
Cvs:s1s2+
P/a: soft, No organomegaly
Cns: drowsy
Pupils b/l reactive to light
Acute urticaria with anaphylaxis
Rescue treatment
Immediately started on supplemental oxygen
inj ADERNLINE - IM (0.01ml/kg) (1:1000) dilution
Required 2 doses 15 min apart
secured Iv cannula , Taken samples (cbc, crp, lft, kft, esr, procalcitonin, C4, c1-inh)
Given crystalloids total 30ml/kg
Inj hydrocortisone
Shifted to picu for further management
Cbc: leukocytes with normal Plateletcount
Crp Negative
Esr normal
Procalcitonin normal
C4 normal c1 esterase inhibitor normal
I/v/o prolonged h/o rashes and intermittent fever investigated for urticarial
vasculitis ANA profile was sent - normal
2d echo _ normal
Treatment Given
Iv fuilds normal maintance
Inj Rantac
Inj Hydrocortisone
Syp cetirizine (increased the dose bcoz of severe itching )
Advice at discharge
1)Syp omnacortil forte(15mg/5ml) 2mg/kg/day for 3 days
1mg/kg/day for 3 days
2)syp Rantac (75mg/5ml) 2mg/kg/day
3) syp cetirizine 10mg (1-0-1) for 2 weeks
If itching is not reduced plan to increase the dose of cetirizine 10mg tid will give for 2 weeks
4)plan for Skin prick test once rash reduces
5)plan to repeat blood investigations if anaphylaxis happens (s tryptase with in 15 mint to 2 hours
and again 24 to 48 hours of complete resolution of symptoms , C4, C1 esterase inhibitor level )
