Spot Diagnosis

You can answer the question shown below with a picture. Immediately after answering the question the correct answer is displayed to you. And you can see previous questions with its correct answers.

Infected Severe Atopic Dermatitis

Mafalda João Pereira, Íris Rocha e Oliveira, Andreia J. Fernandes, Maria João Virtuoso
Pediatric Department, Unidade Local de Saúde do Algarve, Hospital de Faro, Faro, Portugal

Address for Correspondence: Mafalda João Pereira, Hospital de Faro, Rua Leão Penedo, 8000-386 Faro, Portugal.
Email: mjcpereira@chalgarve.min-saude.pt
Keywords : Atopic Dermatitis, Staphylococcus aureus, Skin Infection
Question:
A seven-year-old girl, with a previous history of severe atopic dermatitis (AD) and sensitization to several allergens, presented to the pediatric emergency department (ED). She was previously followed by a Pediatric Allergologist since she was six months-old and medicated daily with desloratadine and topic tacrolimus, plus topic fluticasone propionate in acute flares. She had interrupted her medication for the last two months.
She presented to the ED complaining of pruritic skin lesions, progressively worse during the past week, and gait limited by pain. She denied fever or other symptoms. On physical examination, she displayed xerosis, scaly eczematous lesions, thickening of the skin and an increase in skin markings (lichenification), with extensive and painful impetiginous lesions scattered throughout the body, worse in the lower and upper limbs and around the neck (Images).
Analytically she had an increased C-reactive protein but no leukocytosis, with eosinophils in the upper normal limit (800 cells/uL). Her blood culture was positive for methicillin-sensitive Staphylococcus aureus. Her total IgE was elevated (3340.0 kUI/L) with specific IgE positive for several types of mites and olive tree.
Treatment was initiated with flucloxacillin, daily hygiene with a chlorhexidine solution, skin hydration with application of an emollient (moisturizer) and a topic steroid (betamethasone dipropionate twice daily).
By the time of discharge, there was a clear improvement, with lesions in the healing phase, decreased pruritus, and no functional impairment. She resumed follow-up with the Pediatric Allergologist and resumed treatment with oral antihistamine, topic tacrolimus, and topic steroids in flares.

Figure 1. Infected atopic dermatitis in the back of the neck.


Figure 2. Infected atopic dermatitis in the legs.

Figure 1. Infected atopic dermatitis in the back of the neck
Infected Severe Atopic Dermatitis

What is the diagnosis?

Previous Spot Diagnosis View All

Disclaimer: The information given by www.pediatriconcall.com is provided by medical and paramedical & Health providers voluntarily for display & is meant only for informational purpose. The site does not guarantee the accuracy or authenticity of the information. Use of any information is solely at the user's own risk. The appearance of advertisement or product information in the various section in the website does not constitute an endorsement or approval by Pediatric Oncall of the quality or value of the said product or of claims made by its manufacturer.
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0