Recurrent Rash in an 11-Year-Old Boy With Pericardial and Pleural Effusions

• DOI: 10.1542/peds.2021-055524
• Publication Date: 2022-10-28T08:16:29Z
• Authors: Allison M. Weisnicht; Ryan Byrne; Erin B. Henkel; Stephen A. Harding; Stefan P. Kostelyna; Deborah Schady; Jamie Lai; Leigh A. Stubbs
• Keywords: Myopericarditis; Petechial rash; Mediastinal lymphadenopathy

An 11-year-old, previously healthy boy presented to the emergency center (EC) for acute respiratory distress in setting of 5 months recurrent and worsening rash with progressive fatigue, shortness breath, chest pain, cough. At onset his rash, he younger brothers were diagnosed roseola. Although brothers’ symptoms resolved, patient’s recurred, prompting primary care provider prescribe amoxicillin. The subsequently worsened, so amoxicillin was stopped; a prednisone course prescribed which alleviated rash. Upon completion course, returned more diffusely associated Because these symptoms, mother brought him EC, where vitals notable tachypnea tachycardia. His initial EC imaging workup remarkable an echocardiogram mild moderate circumferential pericardial effusion, x-ray (CXR) large right pleural computerized tomography significant prominent diffuse mediastinal hilar lymphadenopathy numerous enlarged axillary lymph nodes. Laboratory results elevated liver enzymes, inflammatory markers, d-dimer, brain natriuretic peptide. Differential diagnosis remained broad, including infectious, oncologic, rheumatologic etiologies. Our panel experts reviews evaluation, hospital treatment this patient presenting unusual serositis.