By Collin Siedor
There are dozens of illnesses, irritants and allergens that can cause a child to break out in a rash. Most of those rashes aren't very serious and will go away in a few days all by themselves. There is, however, one very serious exception.
"You are a wonderful patient, you know that?" Dr. Kathleen Nelson says to a boy she's examining in the emergency room.
The child doesn't know how dangerous this could be. Three-year-old Justin has what's called a petechiael (pa-teek-ee-al) rash.
"And that is the kind of rash that has red spots under the skin that don't blanche when you touch them or when you pull the skin," Dr. Nelson says.
When Justin takes off his shirt, Dr. Nelson demonstrates to Justin's mother.
"The little blood vessels are broken underneath the skin and when I push on them, they don't fade," she says.
The spots are scattered over his upper back, neck, chest and, in a couple of places, on his face. They're below the skin – tiny hemorrhages, little drops of blood.
Dr. Nelson explains that "fever and petechiael rash is something we take very seriously in pediatrics because it may be a sign of a condition called meningococcemia, which is a very rapidly progressive, serious bacterial infection that can lead to meningitis [and] that can lead to overwhelming infection and it can lead to death."
But there are other possible, only slightly less frightening, causes of a petechiael rash: an immune disorder, low platelet count, infection in the valves of his heart or the bite of a tick. The problem is, after a physical exam, a history and a blood test, all of these get ruled out in Justin's case. So, the nurse marks the rash with dots of ink, in order to see if the rash spreads. Overnight, they wait.
"That was another reason to put him in the hospital over night – to watch the rash and see if it developed any further," Dr. Nelson explains.
If it truly is meningococcemia (men-in-joe-cox-SEE-mee-ah), one critical question remains. Will he develop a fever?
But the next morning, he's fine.
"He never developed a fever and the rash did not progress," Dr. Nelson says. "If anything, it started fading away so we felt pretty comfortable sending him home after 24 hours of observation."
Justin gets to go home, and we may never know what caused his rash.