Pulsating Pruritic Rash After An Insect Bite

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pulsating pruritic rash
The New England Journal Of Medicine©

A 21-month-old baby boy develops a pulsating, pruritic rash after an insect bite.

A 21-month-old baby boy presented to a pediatric emergency department with a 1-day history of a pulsating, pruritic rash on his left leg.

In the emergency department, the patient had a body temperature of 39.2°C. However, heart rate and blood pressure were normal.

Physical examination revealed a healthy baby boy who seemed well. Auscultation revealed no cardiac murmur. However, local examination of the rash on the left leg revealed an edematous and erythematous plaque. Moreover, the plaque demonstrated Quincke’s sign. In other words, it was pulsating with alternating erythema and blanching in synchrony with his pulse.

Quincke’s sign refers to the visible pulsations in the fingernail bed seen in patients with aortic regurgitation or aortic insufficiency. It is an alternating blanching and flushing of a specific site, corresponding to the arterial pulsation.

His doctors suspected the rash to be due to an insect bite. At the site of bite, the baby developed localized vasodilatation and edema. The local arterioles were unable to maintain adequate pressure during diastole, therefore, pulsating blanching and flushing phenomenon was seen.

Since the working diagnosis was of an insect bite, the doctors prescribed him an oral antihistamine called dimethindene maleate. After the first dose, within 3 hours, the pulsations stopped. Moreover, at the 3-day follow-up, the lesion had completely resolved.

References

Moran S. Gal, M. a. (2021, January 28). A Pulsating Leg. Retrieved from The New England Journal Of Medicine: https://www.nejm.org/doi/full/10.1056/NEJMicm2022429

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Dr. Arsia Hanif has been a meritorious Healthcare professional with a proven track record throughout her academic life securing first position in her MCAT examination and then, in 2017, she successfully completed her Bachelors of Medicine and Surgery from Dow University of Health Sciences. She has had the opportunity to apply her theoretical knowledge to the real-life scenarios, as a House Officer (HO) serving at Civil Hospital. Whilst working at the Civil Hospital, she discovered that nothing satisfies her more than helping other humans in need and since then has made a commitment to implement her expertise in the field of medicine to cure the sick and regain the state of health and well-being. Being a Doctor is exactly what you’d think it’s like. She is the colleague at work that everyone wants to know but nobody wants to be. If you want to get something done, you approach her – everyone knows that! She is currently studying with Medical Council of Canada and aspires to be a leading Neurologist someday. Alongside, she has taken up medical writing to exercise her skills of delivering comprehensible version of the otherwise difficult medical literature. Her breaks comprise either of swimming, volunteering services at a Medical Camp or spending time with family.

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