1. Clinical meeting
Presented By
Dr. Mir Aulad Hossain
Assistant Registrar
(FCPS Part-II Trainee)
Department of Paediatrics
Chattogram Maa-O-Shishu General Hospital
2. Particulars of patient
Name : Tasnim
Age : 6years
Sex : Female
Address : Hathazari, Chittagong
Date of admission: -15.07.2022
Date of examination: 17.07.2022
4. History of present illness
According to patient mother statement her child was
reasonably well 6 days back. Then she developed rash which
was first appeared in the extensor surface of both leg then
gradually involved in the buttock, back of chest and trunk.
Initially rash was pink in color than become reddish, non itchy.
rash was not associated with fever and itching. Mother Also
Complaints of abdominal pain for last 3 days which was dull
aching in nature, located around the umbilicus, non radiating
not aggravated or reduced by taking food and not associated
with vomiting.
5. Present illness (cont)
There was no history of fever ,joint pain, joint swelling,
epistaxis, gum bleeding, melena, hematuria no history of
taking any offending drug, exposure to ionizing radiation, . with
these complaints child was consulted with a registered
physician and treated with paracetamol and advice for
hospitalization for further evaluation and management.
6. h/o past illness
h/o sore throat 1 weeks back.
BIRTH HISTORY:
Child was born at term by normal vaginal delivery
No H/o PNA
Antenatal, prenatal, postnatal period was uneventful.
7. Feeding history
Child was on family diet .
IMMUNIZATION HISTORY:
Completely Immunized .
DEVELOPMENT HISTORY:
Age appropriate.
FAMILY HISTORY:
2nd issue of non consanguineous parents
No family member has such type of disease
9. General examination
Appearance: ill looking, conscious; co-operative ,lying in
supine position
i/v cannula in situ. Afebrile,
anemia: mildly pale
Jaundice: absent
Cyanosis: Absent
Edema: Absent
Dehydration: Absent
clubbing: absent
Leuconychia: absent
Koilonychia :absent
10. General examination (Cont)
Vital sign:
Temp: Normal
RR: 26 /min
HR: 90 b/min
BP : 90/50 mm of Hg (below 50th persentile)
BCG Mark: Present
No lymphadenopathy
Ear nose throat: normal
Sign of meningeal irritation: absent
Bony tenderness :absent
11. General examination (Cont)
Skin survey: Maculopapular rash present on the extensor surface of the
both legs, buttock,trunk,back of the chest of varying size and
shape.redish in colour ;rashes are palpable ,not blanced on pressure
and non tender.
Diascopic test : Negative
Anthropometry measurement:
Weight-26 kg WAZ(-1.2 sd)
Height-115 cm HAZ (-1sd)
WHZ(-1SD)
BMI: 19.6
12. Abdominal EXAMINATION:
Abdomen:
Inspection: shape –normal
Umbilicus centrally placed and inverted.
No visible peristalsis , mass or scar mark.
Palpation: tenderness :present at periumbilical region.
No organomegaly present.
Percussion: fluid thrill and
Shifting dullness – absent
Auscultation: bowel sound present
External genitalia-normal
13. NERVOUS SYSTEM:
Higher psychic function: intact
Cranial nerves: intact
Motor function: intact
Sensory function: intact
Co ordination: present
PRECORDIUM EXAMINATION:
Shape of precordium: normal
no visible apical impulse
apex beat: left 5th intercostal space medial
TO mid clavicular line
14. Thrill: absent
Heart rate: 90b/min; regular in character
Heart sound: 1st and 2nd heart sound were audible
in all four cardiac areas
Murmur: absent
CHEST EXAMINATION:
no chest deformity
respiratory/rate: 26b/min
breath sound vesicular
no added sound
16. SALIENT FEATURE:
Tasnim ,6years ,female child,2nd issue of non
consanguineous parents hailing from hathazari admitted in
CMOSHMC with the complaints of rash in different sites of
the body for 6 days. which involving extensor surface of
both lower limb ,buttock ,trunk and back of chest which was
maculopapular , varying size and shape.rashes are palpable
,not blanced on pressure and non tender,reddish in color.
Periumbilical pain for 3 days and no orgalomegaly present .
17. SALIENT FEATURE(Contd)
There was no history of joint pain, joint swelling,
epistaxis, gum bleeding, melena,hematuria no
history of taking any offending drugs, exposure to
ionizing radiation, on examination tasnim was ill
looking afebrile mildly pale, vitals are normal. No
bony tenderness present , BSUA was nil BCG
mark was present, anthropometrically well thriving
.
other systemic examination revels no abnormality.
24. Ultasonography of whole
abdomen :
Mild thickening of bowel wall in right lumbar
region
Partially contracted gall bladder
25. Treatment
Counseling about the disease
Maintenance of fluid and nutrition
Tab paracetamol500 mg
2/3rd +0+2/3rd
Tab cortan 10mg
1+0+1
26. Prognosis
Excellent
15-60% have 1 or more recurrence
Chronic disease develops in 1-2 %
<5% HSP nephritis have ESRD
Long term prognosis depend son severity
and duration of GIT or renal involvement
27. Follow -up
Blood pressure monitoring
Bed side heat coagulation test
Intake output chart
Vital sign:
After discharge f/up upto 4wk but it will be
recurrence within 4-6 month
