<< Pediatric Inflammatory Bowel Disease In The Emergency Department: Managing Flares And Long-Term Complications

Case Presentations and Conclusion For Inflammatory Bowel Disease

A previously healthy 12-year-old boy is brought to the ED by his mother for evaluation of fatigue and skin rash. She has noticed “red bumps” on his legs for the past few weeks, but she reports no other associated symptoms. The patient says he has been feeling tired lately and can’t seem to keep up with his friends on the playground. He states that he sometimes has abdominal cramping after eating but denies diarrhea. He does not recall being bitten by insects on his legs and says those red bumps “hurt just a little.” On physical examination, you note a thin and mildly pale-appearing boy, who is small for his age. He has normal affect and behavior. Vital signs are: oral temperature, 36.3°C; heart rate, 89 beats/min; respiratory rate, 18 breaths/min; blood pressure, 103/65 mm Hg; and oxygen saturation, 99% on room air. Several well-circumscribed, minimally tender, nonweeping and nonblanching erythematous nodules are noted on the bilateral anterior tibia. There is no surrounding fluctuance, crepitus, or bullae. The only significant finding on review of his past medical history is his growth chart. You are concerned that the nodules on his legs may be indicative of systemic disease, and you consider your diagnostic options...

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