Simple cases
Case 10
8-year-old girl with linear erythema on right forearm
History
How long has your child had this problem?
Her right hand has been red and swollen since yesterday. The streaks on her arm just started suddenly.
Good question. This skin disorder appears suddenly and spreads rapidly.
Has she had fever or chills?
No, she's actually fine but her arm hurts.
Good question. Systemic findings are not uncommon.
Does she have a cancer?
No, she's had the usual childhood diseases, but is otherwise fine.
This question doesn't help and may scare the mother and child.
Did she hurt her hand or get an insect bite there?
At first we thought it was an insect bite. It is was red, swollen and itched like crazy. Then as it started to spread, we weren't sure.
Good question. This disorder always starts at an entry site.
Does she has pain in her armpit?
She says there is a pressure or pain there.
Good question. Be sure to check on physical examination.
Dopes your daughter have asthma or hay fever?
No. She's never had allergies.
This question is not relevant here.
Lesion
Choose the right efflorescences:
Correct. There is an erythematous, poorly circumscribed, puffy, warm nodule over the hypothenar eminence.
Correct. Spreading proximally is a linear erythematous macule.
False. No hives are present.
False. No papules are seen.
False. No vesicles are seen.
Diagnosis
Choose the right diagnosis:
False. Erysipelas is a bacterial infection which spreads diffusely, not in a linear fashion.
Correct. Lymphangitis is an infection of one or more lymphatic vessels usually caused by streptococci or staphylococci.
False. Impetigo is a vesicular and later crusted superficial streptococcal infection.
False. Erythema nodosum is triggered by medications or infections and presents with tender nodules usually on the shins.
Therapy
Choose the right therapy(ies):
False. Systemic corticosteroids are usually contraindicated in infections.
Correct. The rapid administration of a systemic antibiotic is essential. In this case, penicillin was given.
False. They fail to reach the deeper lymphatics.
Correct. This simple measure will bring good pain relief.
Correct. An infected limb should be immobilized to reduce spread of infection.
