Sickle Cell Patient with a Rash!

[Sarah-cali]

A 7 year old child with history of sickle cell disease presented to the ER with widespread petichial rash over the lower limbs and trunk and high grade fever. OE: the child was stuporous and had yellow sclera

Labs showed:

• WBC 12000 / cubic mm
• RBC 5 million / cubic mm
• Hb 7 g/dl
• Blood film showed microcytosis, hypochromia, and fragmented RBCs
• Platelets 25000 / cubic mm
• BUN 55 mg/dl and creatinine 1.6 mg/dl
• Urine positive for hemoglobin and protein 3+

What is the most likely diagnosis?
a- DIC
b- HUS
c- HSP
e- Meningococcemia
f- Parvovirus B19 infection

[DrSeddik]

This is one difficult quesetion, could be a or b, but again, both are not associated with this kind of proteinuria.

I choose b

[YoramFishke]

I also choose B

[HouseWannabe]

Don't want to be the odd one out, but i think it's F.

(B19)Fifth disease causing aplastic crisis in a sickle cell patient... i know the rash is supposed to be "slapped cheek" but there is rash on the rest of their body too....

If not, then my second choice would be HSP...

[Sarah-cali]

• In DIC you should see fibrinogen and FDP results in the question and also renal failure and intavascular hemolysis are not characteristic.
• In HSP you have palpable purpura rather than petichiae and unlikely to see the child in such a disastrous semi comatose status.
• In meningococcemia you can have all of these but the fragmented RBCs and the hemolysis should point to a more likely diagnosis.
• In Parvo B19 you have aplastic crisis but you unlikely to see jaundice, hemolysis, and renal failure.

I guess you now know what's the correct answer

[DrSeddik]

Why the decreased platelet count??

[Sarah-cali]

Originally Posted by DrSeddik

Why the decreased platelet count??

Hemolytic Uremic syndrome characterized by a triad of microangiopathic hemolytic anemia, thrombocytopenia, and acute renal failure

[Sarah-cali]

Why nobody is thanking me for this question

[DrSeddik]

Originally Posted by Sarah-cali

Why nobody is thanking me for this question

The question is very confusing that's why? I nearly hit a wall while I was reading it.

Ofcourse it's a typical USMLE question, they love to see heads going through walls.

[DrSeddik]

Originally Posted by Sarah-cali

Hemolytic Uremic syndrome characterized by a triad of microangiopathic hemolytic anemia, thrombocytopenia, and acute renal failure

OOh ofcourse, I though you said HSP was the answer..

[oviedo]

I think it's HUS