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Pinpoint red spots on skin not itchy5/2/2024 ![]() Adhering to the local protocol is advised. Investigations to diagnose the cause of a petechial rash depend on the clinical presentation and can differ from one PED to another. Patterns of concerning symptoms and signs presenting with petechiae include but are not limited to: The age of the child can be useful in reaching the most likely diagnosis, for example, a neonate with petechiae could have a NAIT or a TORCH infection, and HSP is more common in the 2 to 5 year age range. Demarcating areas of petechiae with a skin marker can help monitor the progression of the rash in clinical practice. The skin should undergo thorough examination from head to toe, and the pattern of rash requires clear documentation. A full systemic examination should be completed, including cardiac, respiratory, abdominal, otorhinolaryngological, and neurological (if concerns of IMD). ![]() On examination, a complete set of observations and neurological status requires monitoring. As always, the clinician should confirm vaccination status. It is also important to ask about any bleeding from mucosal surfaces such as gingival bleeding, epistaxis, melena, among others. Petechiae confined to above the nipple line are associated with bouts of vomiting or coughing. A recent viral infection (URTI or gastroenteritis) is common in ITP, HSP, and HUS. A rapidly spreading rash is more concerning for IMD in an unwell child with a fever. Key features in the history include the time of onset, anatomical pattern and a detailed chronological account of any other symptoms, e.g., fever, coughing, vomiting, any recent URTI or gastroenteritis, and any sick contacts. A detailed history and physical examination are paramount for every child presenting with petechiae.
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