A 7-year-old boy arrives at the emergency room in acute
distress. Over the past 3 to 4 days he has become progressively ill with
generalized fatigue and mild, mid-abdominal pain that have become steadily
worse. On physical examination he has a maculopapular rash on his thighs and
feet with some spread of the rash to his buttocks. The rash does not blanch and
the some lesions near the ankles look petechial or bruised. His temperature is
39.0 C(102.2 F) and he is drawing his knees to his chest for relief of his
stomach pains. He is nauseated and vomited once before coming to the hospital.
He has semi-soft dark stool, which is guaiac-positive. The boy has not voided
since early morning and cannot provide a urine sample. The doctor determines
that he is 10% dehydrated and asks the nurse to start intravenous fluids. Which
of the following is the most likely diagnosis?
The correct answer is D. Henoch Schonlein purpura
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