- Pediatric Annals
- August 2010 - Volume 39 · Issue 8: 467-470
This 14-year-old previously healthy girl presents with a 6-week history of increasing fatigue, weakness, and pallor. She was well until 6 weeks before admission when she went on a 2-week Mediterranean cruise with her family. During the cruise, she started having nasal congestion and rhinorrhea. Upon returning home, she was prescribed a 10-day course of Augmentin for possible sinusitis by one of her parents who is a nurse practitioner, which was said to have helped the symptoms. She then went to sleep-away camp, during which time she began to feel fatigued and developed persistent rhinorrhea. In addition, she had been experiencing temperatures ranging from 100 to 101.5°F. For the last week, she has complained of thigh and knee pain while walking and “purplish-red bumps” on her feet, ankles, knees, and wrists. On review of systems, she complained of intermittent epistaxis whenever she “blows her nose hard.” She has had occasional aphthous ulcers and intermittent abdominal pain during this time.
Dr. Listernick is professor of pediatrics at Feinberg School of Medicine, Northwestern University, and director of the Diagnostic and Consultation Service, Division of General Academic Pediatrics, Children’s Memorial Hospital, Chicago, IL