21 day old infant comes in my office tonight with a rash that looks
urticarial--patchy, red to purple lesions, blanching with slight edema. If I'd
seen this in the nursery, I would have thought erythema toxicum...but it only
started today and the kid is 3 weeks old.
Breast-feeding "6 or 7 times a day" but "still seems hungry"...getting about 6
oz/day of Enfamil. Birth wt 8 #13; 2 week check-up wt. 7#13. (PMD, according
to mom, "just told me to keep breast-feeding".) Today's weight--7#14 ounces.
Baby is lively and pink; not the greatest body fat in the world, but not
dehydrated. Peeing and pooping fine; some spits which have become more
forceful over past 24 hours. Afebrile. Mom swears he's been inside the whole
time and has not been mosquito-bitten...but this is Minnesota....
I'm thinking enterovirus at the top of my differential. Can you see
allergy-induced urticaria in this young of an infant, possibly reacting to
cow's milk protein? Would erythema toxicum even be a consideration this far
out? Would you give him Benadryl (I'm observing him in the hospital overnight
while I get labs.)
Any ideas would be great! I can e-mail photos of the rash if you want.
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