A 12-year-old white girl presents to the emergency department with a 1-day history of fever, severe headache, photophobia, nuchal rigidity, and mydriasis. She was evaluated at urgent care 1 day before presentation due to 4 days of acute onset of sharp right upper extremity pain and 1 day of rash over the right upper extremity and shoulder. There, she was diagnosed as having shingles and was sent home with a prescription for acyclovir, of which she was able to tolerate 1 dose. Emergency department physical examination reveals an afebrile, tired-appearing girl in mild distress with cranial nerves II-XII grossly intact, photophobia, nuchal rigidity, and a nonpruritic, erythematous, blanching maculopapular and vesicular rash in the C5-C6 dermatome distribution of the right upper extremity (Figs 1 and 2). She denies nausea, vomiting, abdominal pain, or any new medications, recent stressful events, trauma, infections, or illnesses. Immunizations are up to date,...
Case 4: Unexpected Rash in a 12-year-old Girl
Dr Kratlian’s current affliation is Tufts Medical Center, Boston, MA. Drs Kratlian, Hopkins-Braddock, and Tristram have disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.
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Christina M. Kratlian, Patricia Hopkins-Braddock, Debra Tristram; Case 4: Unexpected Rash in a 12-year-old Girl. Pediatr Rev May 2020; 41 (5): 256–258. https://doi.org/10.1542/pir.2019-0239
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