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Progressive Rash and Arthralgias in a Teenage Male


PT Video: A short course of steroids was ineffective. He returns to ED c/o worsening joint and abdominal pain. Can you Dx?

A 16 y/o male presents with 9 days palpable, purpuric, non-pruritic rash that began on legs and spread quickly upwards; also c/o polyarticular arthritis, abdominal pain. Mild improvement after short course of steroids, finished 2 days ago. Joint/abdominal pain now worse. PMH, noncontributory; no sick contacts. What else do you need to know?


What is your initial impression?

A. Henoch-Schönlein purpura
B. Epstein-Barr virus infection
C. Juvenile idiopathic arthritis (Still’s disease)
D. Systemic lupus erythromatosis (SLE)
E. Thrombocytopenic disease (ITP, TTP, DIC)
F. Rickettsial disease
G. Purpura fulminans
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