Repositório Científico da Unidade Local de Saúde de Santo António
Scientific Repository of the ULS Santo António
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Purpuric rash in an adolescent
Melo, Joana; Margalha Miranda, Ana; Pereira Fernandes Garcês, Sónia
A previously healthy 17-year-old girl presented to the emergency
department with a 14-day history of fever, sore throat, and
a generalized reddish-purple pruritic rash. The rash, initially
erythematous and maculopapular, worsened and became coalescent
and purpuric. She had been treated with azithromycin for three days
starting on the third day of illness. Physical examination revealed
a good general condition, pharyngeal erythema with exudate, and
a purpuric rash covering the body, including the face, palms, and
soles, without other systemic signs. Serological tests confirmed
a diagnosis of acute infectious mononucleosis. The patient was
managed conservatively and had fully recovery at re-evaluation, 50
days after symptom onset. Acute infectious mononucleosis typically
presents with fever, cervical lymphadenopathy, and tonsillitis/
pharyngitis, with spontaneous exanthema occurring in 3-15% of
cases. This case highlights the importance of considering acute
infectious mononucleosis in adolescents presenting with purpuric
exanthema and the potential for antibiotic-associated rash including
azithromycin, emphasizing the need for thorough clinical and
serological evaluation.
Ulcerative skin lesions – what is the diagnosis?
Foles, Ana; Carvalho, Rita; Moreira, Biana; Cachão, Joana
Ecthyma is an ulcerative skin infection, usually caused by group A
beta-hemolytic Streptococcus.
High temperatures and humidity facilitate the development of the
disease, which is particularly common among travelers returning
from tropical countries. Early diagnosis and adequate treatment,
with systemic antibiotics and local intervention, is essential to
minimize the risk of complications.
The authors present the case of an 11-year-old boy with exuberant
ecthyma lesions conditioning severe pain, which prevented walking.
Feeding difficulties in the offspring of mothers with an eating disorder - a case report
Carvalho e Marques, Pedro; Sá, Teresa; Martins, Vânia
Background: One of the main risk factors for eating disorders (ED) in early childhood is maternal ED. Mothers with a history of ED have
difficulties in their approach to feeding their children, with mealtimes being perceived as stressful, with controlling behavior and intrusiveness.
Case presentation: An 11-month-old female infant was evaluated at a Child Psychiatry Consultation for feeding difficulties. Her mother had a
history of Restrictive Anorexia Nervosa. Mother-child psychotherapy was performed due to a pattern of insecure attachment and an ongoing
conflict over control and autonomy between the caregiver-child. After the intervention, mealtimes became more natural and less conflictual.
Discussion and conclusion: The authors aim to shed light on the transgenerational transmission of ED. Feeding interactions between
mothers with ED and their offspring are less harmonious, with greater conflict, controlling behaviors, negative affect and decreased
emotional availability to the child. Clinicians must be aware of a potential parental history of ED when dealing with children with feeding
problems.
Phytophotodermatitis: a challenging diagnosis in children
Costa, Ana Isabel; Vilarinho, Catarina; Pereira, Olga
Phytophotodermatitis, a form of plant dermatitis, is a common phototoxic reaction resulting from the interaction between photosensitising
botanical substances present in several common plant families and ultraviolet radiation. We report a case of phytophotodermatitis in an
8-month-old infant who presented a progressively well-demarcated erythematous rash with blisters and subsequent erosions covering both
upper limbs and feet. Additionally, asymmetric hyperpigmented streaks with bizarre configurations, were observerd in photo-exposed areas.
The diagnosis of phytophotodermatitis was established based on the history of outdoor activities with sun exposure and physical examination
findings. Topical treatment with antibiotic and corticosteroid cream was started. The phytophotodermatitis is a self-limiting condition, which
can be challenging to diagnosis in this age group due to heterogeneity of clinical manifestations, which can mimic a range of different diseases,
such as non-accidental injury in the context of child abuse, potentially delaying timely diagnosis and treatment.
Wait-and-see approach in a paediatric patient with Neuroblastoma with Metastatic Disease
Moreira, Biana; Foles, Ana; Silva, Diana; Gonçalves, Pierre
Neuroblastoma is the most common extracranial solid tumour in the paediatric population, accounting for approximately 8-10% of all
childhood cancers. It arises from the abnormal proliferation of embryonic neural crest cells which normally give rise to the sympathetic
nervous system (SNS) and the adrenal gland medulla. Its prognosis is uniquely heterogeneous, with some children experiencing spontaneous
regression, while others develop widespread metastatic disease with poor outcomes despite aggressive multimodal therapy. Treatment choice
dependents on risk stratification based on the patient’s age at diagnosis and tumour characteristics, such as stage and biological features.
We describe the case of an infant who presents with hepatic metastasis secondary to a solid tumour in the left adrenal gland, classified as
stage MS according to the INRGSS classification. A wait-and-see approach was adopted, with clinical, analytic and radiologic surveillance,
verifying spontaneous regression of the tumour afterwards.