Clinical Quiz
The Hong Kong Practitioner VOLUME 30 / June 2008

A lady presenting with non-pruritic maculopapular rash
Keith K Lau Bsx

A clinical quiz is published in The Hong Kong Practitioner. Readers are invited to participate and a prize draw, sponsored by Pfizer Corporation Hong Kong Limited, will be undertaken among the successful entries. For entry into the draw, simply answer the question, fill in the reply slip and return it to the College by 31 July, 2008. Each reader is allowed to submit one entry only. The name of the winner and the answer will be published in the September issue.

Clinical history:

An 18-year old girl presented with non-pruritic maculopapular rash on the extensor surfaces of her upper and lower limbs. The small petechial lesions coalesced into red-brown patches in the next 3 to 4 days.

She was initially admitted 1 week earlier due to left subclavian deep vein thrombosis. Heparin was started at the beginning but was switched to warfarin 2 days before onset of the rashes. She was afebrile and non-toxic. Laboratory tests were negative for thrombocytopenia and electrolyte disturbances. All cultures were also negative.

The slide and the question were prepared by:
Dr Keith K Lau,
MBBS (HK), Dip. American Board of Paediatrics (USA), FHKCPaed, FHKAM(Paed)
Assistant Professor,
Department of Paediatrics, University of California, Davis.

What is your diagnosis?

A. Heparin induced thrombocytopenia
B. Warfarin-induced leukocytoclastic vasculitis
C. Rocky mountain spotted fever
D. Meningococcemia

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