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Page 4 / Case 09/02

Present medications included:
1) Fluticasone 50 mcg/puff 2 puffs bid
2) Salbutamol 100 mcg/puff 1-2 puffs prn Q4h

Physical exam on transfer to our hospital showed a pale, blonde, boy with growth parameters Weight < 3%, Height <5%, Wt/Ht 88% predicted.

Respiratory rate 48, pulse 140, O2 sat 98% in 1 L O2. He was barrel chested. On chest exam he had tracheal tug, nasal flaring, sternal retractions, bilateral inspiratory crackles but no wheeze.

Skin revealed lesions on his nose, scalp, and groin. The nose lesions look like petechiae with scaling. The scalp lesions were of three different descriptions:
1) yellow hairless nodule on vertex adjacent to the middle lamboid suture
2) localized scaling
3) localized petechiae adjacent to the nodule

The groin diaper area was well demarcated with erythematous plaques containing a few pustules. These lesions were also visible at the base of the penis and perianal fissures.
While on steroids he developed an erythematous rash with bullae between his 3rd and 4th fingers.

WHAT IS YOUR DIFFERENTIAL DIAGNOSIS NOW?

WHAT FURTHER INVESTIGATIONS WOULD YOU DO AT THIS POINT?


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