Diseases in Pediatrics
The manifestation of rashes, red macula, palmer redness, and fever may point at either allergy, infection or a metabolic disorder. The differential diagnoses in this case include primary irritative diaper dermatitis, Wilson’s disease, contact dermatitis- allergy, candidiasis an infection, and gangliosidosis which is a lysosomal metabolic disorder.
The fundoscopy finding of red macula is indicative of neuronal insult due to metabolic disorder. In gangliosidosis, there is difficulty in neuronal cells to catabolize gangliosides (Stephen, 2018) which end up piling in the neurons found in the macula making it to appear red. The rash in the diaper area may be due to contact allergy with the diaper used or an infection with candida (Fernandes, Machado, & Oliveira, 2009). In infection, there is usually elevated temperature causing the fever. The palmer redness is likely to a condition affecting the liver hence Wilson disease come into question (Sullivan, Chopdar, & Shun-Shin, 2002). The redness may be due to accumulation of copper in the liver.
Candidiasis is one of the differential diagnosis that is of concern because it can cause the rash in diaper area due wetness. It can also cause the fever. Fever in children is a major concern because of the dehydration effect (Fernandes, Machado, & Oliveira, 2009). The dehydration in children can complicate since it reduces blood volume which may reduce the renal blood flow. Reduced renal flow can end up causing acute pre-renal kidney failure. If not intervened it can progress to intrarenal kidney failure which is irreversible.
The additional diagnostic test that I will request includes 24 hour urine collection for urine copper, Kayser-Fleischer rings for corneal copper deposits (Sullivan, Chopdar, & Shun-Shin, 2002) and enzyme assay to test for the metabolic disorder (Stephen, 2018). `
The focus in this patient will be the fever and the vital sign. The fever can cause more damage if there is no intervention. Therefore, paracetamol should be administered as the cause is being established. The patient should be given plenty fluids to reduce the effect caused by diaphoresis.
1. Fernandes, J. D., Machado, M. C. R., & Oliveira, Z. N. P. de. (2009). Clinical presentation and treatment of diaper dermatitis: part II. Anais Brasileiros de Dermatologia, 84(1), 47–54. https://doi.org/10.1590/S0365-05962009000100007
2. Stephen, N. (2018). GM1 Gangliosidosis Workup: Approach Considerations, Laboratory Studies, Imaging Studies. Retrieved May 29, 2018, from https://emedicine.medscape.com/article/951637-workup
3. Sullivan, C. A., Chopdar, A., & Shun-Shin, G. A. (2002). Dense Kayser-Fleischer ring in asymptomatic Wilson’s disease (hepatolenticular degeneration). The British Journal of Ophthalmology, 86(1), 114.