Answer to the last #DiagnosticDilemma
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Answer to the last D/D (A 3-year-old girl presented with recent upper respiratory infection and new pruritic blanching rash) is Urticaria Multiforme.

The parents described a viral respiratory illness that had occurred 1 week earlier. Fever (38.8°C) developed on day 2, when the child was at home, as did a generalized polycyclic annular rash with wheals and ecchymotic centers. On day 3, the child returned to the emergency department with a persistent low-grade fever and swelling of the hands, feet, and face. Physical examination was notable for acral edema and a blanching arcuate urticarial rash.

Dermographism was elicited by pressure from a pen. There was no mucosal involvement. Complete blood count, urinalysis, and serum chemical analysis were unremarkable. A diagnosis of urticaria multiforme was made, and the child was treated with diphenhydramine. The rash resolved on day 6 with no further sequelae.

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Source: NEJM
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