Clinical Case 083: Itchy britches

Hi readers – another case-based quiz for you all.

In case you had not noticed – it is Paeds month here at Broome Docs.  So, apologies to all you adult docs out there.

This case falls into the category of Boring EM. {check it out if you like common, everyday ED pearls}

A 17 month old girl is brought into the ED at 2 in the morning.   Her mother has spent the last few nights trying to get her settled – but she keeps waking up crying and irritable.  She is scratching her perineum in her sleep and mum is concerned that she might be developing a UTI. Mum has been changing her nappy regularly – and she says it all looks normal to her.

She is otherwidse well, growing and developing normally.  No history of UTI.

On examination – her abdomen is soft.  Urinalysis is normal – maybe a few red cells – but expected on the history.

“More is missed by not looking than by not knowing” as spoken by Dr Thomas McCrae, [protege of Osler].

So, always examine the perineum of children.  This is often overlooked – but as you will find – many diseases manifest themselves in this area – and it can often be the clue in Paeds that clinches an otherwise perplexing cluster of symptoms into a diagnosis.

So I had a quick look.  Her vulva was a bit inflammed.  And then I saw the problem.  Diagnosis confirmed!

Q1.  What did I see?

Q2.  What is the treatment?

Q3.  What are the possible [albeit rare] complications of this disease?

Be a Broome Docs Quiz legend and get your answers in first. C