Walk through this case of unexplained bruising in a young boy that proves signs and symptoms are not always what they appear to be.
No past bruising, nosebleeds; change in platelets from 45,000 ~4-5 days ago to 245,000--CBC normal. Vitals, WNL; active, well nourished.
Not bruising; rather discolored linear and whorled hyperpigmentation including denuded area (arrow) that resembles a burn.
Lime juice smeared on the skin that leaves a mark could be identified as: a drug reaction; a yet-to-be-determined hematologic disorder; phytophotodermatits.
Furocoumarins (psoralens), present in wide variety of plants react with sunlight, causing a photosensitive reaction.
Re-enactment of the mother's recent behavior with the child demonstrates a perfect match. Another case of phytophotodermatitis related to limes!
The slides above present 2 very interesting cases where presenting signs were not at all what they appeared to be. Dr Jonathan Schneider provides a compact lesson in diagnostics with a flash-back to his early days in medicine.Â