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It is easy to misdiagnose
Written by | Wu Jun
On weekend nights, my cousin's daughter Rui Rui sent me a WeChat message: "Auntie, my baby is 1 and a half years old, and he had a fever the next day after getting the MMB vaccine, and now he has a fever for 3 days in a row. The day before yesterday, only the neutrophils were a little higher, and today's blood routine was very abnormal, and the doctor hospitalized him. Could it be a blood disease?"
Fig.1 Abnormal blood routine results
Day 1: WeChat consultation needs to be vigilant
I asked about the general situation of the baby Ruirui, and she told me: "Although the child's fever can reach a maximum of 39.7 °C, his mental state is okay, but his appetite is not as good as before, and he does not have the strength to walk as before, and he has a little diarrhea today." ”
Although the results of this routine blood test are obviously abnormal and do not rule out the possibility of blood diseases, when diagnosing diseases, we should always follow the diagnostic principle of considering common diseases first and then rare diseases:
1 1/2 years old, high fever, good general condition, leukopenia and thrombocytopenia, this child still has to think of the possibility of viral infection, especially infantile eruption.
Since I started my career, I have seen many cases of infantile eruption that have been manifested in leukopenia and/or thrombocytopenia during the course of the disease, and the summary of these cases has allowed me to reflexively infer the accurate diagnosis of the disease when I see similar cases again.
So I suggested that Rui Rui should not take the baby to the hospital for the time being, and observe at home for a day or two, and then say, from my clinical experience, the baby is likely to have infantile rash. In order to further soothe her restless mood, I told her with some confidence: "I guess the baby will have a fever tomorrow and then have a rash." ”
The next day: At noon, the baby really had a rash
Rui Rui sent me a few photos of the baby and told me excitedly: "Auntie, the baby's body temperature has gradually dropped today and he has begun to have a rash. My niece, who has high emotional intelligence, did not forget to take the opportunity to be a "sycophant": "Auntie is amazing, fortunately the baby was not hospitalized, otherwise she would have been tossed again." I immediately gave a thumbs up.
Fig.2. "Fever reduces"
At this point, I breathed a long sigh of relief, and this risky telepathy mission was finally successfully completed. Because infantile rash is a common and misdiagnosed disease in pediatrics, no matter how clever a doctor can be sure that his diagnosis is correct before the child's rash comes out. Moreover, jumping to conclusions without personally examining the child is also one of the reasons why I am worried that the WeChat consultation may fail.
What is infantile eruption?
Infantile rash, also known as infantile roseola and the sixth disease, is a common disease characterized by high fever and rash in infants and young children, which mostly occurs in spring and autumn.
▌ Pathogen
The main pathogen is human herpesvirus type 6 (HHV-6), and the other pathogen is human herpesvirus type 7 (HHV-7), which accounts for 10% of the causes of eruption in young children.
▌Clinical manifestations
Infantile exanthema mainly occurs in infants and young children under 3 years old, especially in children aged 6~18 months, and 90% of children are less than 1 year old. Babies often have sudden high fever, body temperature as much as 39 °C or even higher, persistent, may have a slight cough or diarrhea, may be accompanied by irritability, good mental appetite, body temperature drops after 3~5 days, 12~24 hours after the fever is relieved, the skin appears 2~3mm size of light red maculopapular rash, seen on the face and trunk, can last 2~3 days. On physical examination, doctors will find characteristic erythema on the soft palate in some children.
In addition, only 40% of children with primary HHV-6 infection showed infantile eruption, and the rest did not have typical infantile eruption symptoms, but only fever was the clinical manifestation.
▌Differential diagnosis
Infantile eruptions are difficult to diagnose early because the initial signs and symptoms of the disease are similar to those of other common childhood disorders.
It is easy to be misdiagnosed as acute upper respiratory tract infection when the fever is short, easy to be misdiagnosed as Kawasaki disease, Epstein-Barr virus, adenovirus infection when the fever is long, enterovirus infection when there are diarrhea symptoms, and easy to be misdiagnosed as rubella, measles and other exanthematine diseases when the rash occurs.
Seeing the "fever and rash" can confirm the diagnosis of infantile eruption, which can also help us identify other pediatric eruptive diseases.
Children with infantile eruptions are generally in better condition, and the blood picture can gradually return to normal within 1-2 weeks, which also helps to distinguish it from blood disorders.
▌ Complications
In addition to high fever, the clinical manifestations of infantile exanthema are generally mild, but it can be complicated by benign intracranial hypertension, febrile seizures, meningitis or encephalitis, myocardial damage, liver damage, neutropenia, thrombocytopenia, etc. Twenty percent of febrile seizures are due to primary infection with HHV-6, and some patients present with status epilepticus.
▌ Treatment
Infantile exanthema is a self-limiting condition for which there is no specific drug.
When your child has a fever, they can be cooled physically, such as applying a cold towel to their forehead or groin, or if they are particularly uncomfortable with the fever, they can take an oral fever reducer. Make sure your child is hydrated, let them drink plenty of water, if they don't like to drink plain water, drink some juice, and eat some nutritious and easily digestible food. Mom and Dad don't need to be nervous when they see the child covered in a red rash, the rash will not scar, peel and darken after the rash subsides.
What abnormal changes in the blood routine can be caused by infantile eruptions?
Q1
Do you know what blood changes will be caused by children's rash? Scan the code or click at the end of the article to read the original article and see the answer~
Bibliography:
[1] Liu Mingquan.Retrospective analysis of the clinical characteristics of 102 cases of infantile eruption[J].Chinese Pediatrics of Integrated Traditional and Western Medicine,2011,03(6):551-552.
[2] Wang Chu.Clinical analysis of 523 cases of infantile eruption[D].Chongqing Medical University,2014:1-46.
[3] Agut H, Bonnafous P, Gautheret-Dejean A. Laboratory and clinical aspects of human herpesvirus 6 infections. Clin Microbiol Rev. 2015; 28(2):313-335.
[4] Zhao Zhiqing, Li Hong, Han Jie.Analysis of 54 cases of infantile eruption complicated with thrombocytopenia[J].Chinese Journal of Misdiagnosis,2009,9(19):4704-4705.
[5] Wang Tianyou, Shen Kunling, Shen Ying. Zhu Futang Practical Pediatrics[M]. Beijing: People's Medical Publishing House, 2022.
[6] Zhu Lili.Clinical analysis of infantile eruption complicated by multi-organ injury[J].China Practical Medicine,2015,(14):119-120.
[7] Wu Jun, Chen Lin.What is the disease of a 1-year-old doll with high fever and abnormal blood?Medical Pediatric Channel2021-11-181.
Editor in charge: Xiang Yu
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