62. Two Brothers With a Rash
Session: Posters in the Park: Posters in the Park
Wednesday, October 3, 2018: 5:30 PM
Room: N Hall D Opening Reception and Posters in the Park Area
Posters
  • ID Week Case Draft Final 100118_JCRJDW 1.gif (1.6 MB)
  • Two Brothers With a Rash

    HPI

    • 12 y M presenting with fever up to 102.5, rash and arthralgias for 4 days and 1 day of sore throat
    • Non-pruritic rash progressed from upper arms and torso, to lower body, face, involving palms and soles
    • White spots on roof of the mouth, tonsillar exudate, lip swelling
    • Symmetric joint pain with swelling, elbows, knees, PIP

    Pertinent History

    • Three sick contacts with similar rash
    • Travel: Michigan, non-outdoor activities
    • No tick, mosquito, or animal exposures
    • No change/exposure to medications
    • Immunizations: UTD
    • PMH: ADHD

    Examination

    • VS: T 36.6 HR 73 RR 22 BP 104/42 SpO2 97%
    • Pharynx: pinpoint erythematous lesions on posterior pharynx and hard palate
    • Mild edema of bilateral PIP, knees, 2+ pedal edema
    • Erythematous blanching patches UE/LE, confluent trunk, buttocks, back, face affected; involving palms and soles

    Laboratory

    • WBC 10.1 (103/µL) N66 L23 M7 E4
    • CRP 49 mg/L; ESR 37 mm/Hr
    • RVP negative
    • EBV: EA IgG Ab (-), EBNA (+), VCA IgG (+), VCA IgM (-)
    • Rubella IgG (+), IgM (-)

    Differential Diagnosis

    • Type 1 Hypersensitivity Reaction
    • Erythema Multiforme triggered by viral v. group A streptococcal infection
    • Parvovirus Infection
    • Rickettsial Diseases (Rocky Mountain Spotted Fever, Murine Typhus)
    • Kawasaki Disease
    • Connective Tissue Disease (JIA, SLE)
    • Epstein/Barr Virus Infection
    • Measles
    • Acute Rheumatic Fever

    Teaching Points

    • Arcanobacterium haemolyticum is a pleomorphic, beta-hemolytic, facultative anaerobic, Gram-positive rod
    • Originally known as Corynebacterium haemolyticum, first described in 1946 as the etiology of pharyngitis and rash (1)
    • Rarely can cause sepsis, brain abscess, endocarditis, and osteomyelitis (2-4)
    • Acute pharyngitis caused by A. haemolyticum is often indistinguishable from group A streptococcal infection
    • Strawberry tongue absent
    • Maculopapular or scarlatiniform rash usually spares palms and soles
    • Rash usually occurs after the pharyngitis
    • Spread is person to person (sibling presented identically) via droplet respiratory tract secretions

    Treatment

    • Erythromycin is the drug of choice
    • Azithromycin, clindamycin, vancomycin and tetracyclines may also be effective
    • Usually resistant to TMP/SMX
    • Patient 1 resolved by the time the culture revealed A. haemolyticum, patient 2 received azithromycin with complete resolution

    References

    1. Maclean, P.D., Liebow, A.A., & Rosenberg, A.A. (1946). A hemolytic corynebacterium resembling Corynebacterium ovis and Corynebacterium pyogenes in man. J Infect Dis 79, 69-90. PMID 20996930
    2. Wong, V., Turmezei, T., Cartmill, M. & Soo, S. (2011). Infective endocarditis caused by Arcanobacterium haemolyticum: a case report. Ann Clin Microbiol Antimicrob 10, 17. PMID 21569379
    3. Jobanputra, R.S. & Swain, C.P. (1975). Septicaemia due to Corynebacterium haemolyticum. J Clin Pathol 28, 798-800. PMID 1214013
    4. Vargas, J. et al. (2006). Brain abscess due to Arcanobacterium haemolyticum after dental extraction. Clin Infect Dis 42, 1810-1811. PMID 16705595
    Luis Castagnini, MD, Children's Hospital of San Antonio, San Antonio, TX, Julie D Wohrley, MD, Pediatrics, Section Infectious Disease, University of Chicago, Comer Children's Hospital, Chicago, IL and Julia C. Rosebush, D.O., Pediatrics (Infectious Diseases), Comer Children's Hospital / University of Chicago, Chicago, IL

    Disclosures:

    L. Castagnini, None

    J. D. Wohrley, None

    J. C. Rosebush, None

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