ID:

Name: Rami Maqboul

Age: 5 years
Address: Nablus
Date of admission: 2/1/2013
Date of History taking: 2/1/2013

Informant:
Parents and they were reliable

Chief Complain:
Abdominal pain and rash of 5 days duration prior to admission

History of present illness:

Rami was in his usual state of health until 5 days prior to
admission when he started to complain from sudden moderate
abdominal pain. The pain was diffuse and continuous associated
with erythmatous nonprurtic skin rash started on feet that
appeared 1 day after abdominal pain, the pain abdominal pain
was not associated with neither fever, nor diarrhea or vomiting.
His father took Rami to dermatologist and the doctor prescribed
him some medications which the father cant remember. After
taking the medications the abdominal pain was relieved, but the
rash still remain.
Yesterday, the abdominal pain returned again and become more
severe which Rami cant tolerate, there was no diarrhea and

vomiting. The rash progressed to involve lower extremities and

buttocks. Suddenly Rami cant stand up from his bed and
complained from knees pain.
Upon history the mother mentioned that Rami complained from
pharyngitis in the last 7 days before this illness, and he was
treated with antibiotics and improved.
There was no history of frequency, urgency, joints swelling,
headache, seizures, edema, and changes in urine and stool color.
On 2/1/2013 Rami came to Rafidia hospital and then admitted
through ER to pediatrics department

Systemic Reviews:
1) General: decreased appetite, decreased activity, no fever, no
weight loss
2) Skin: erythmatous no pruritic rashe, no pigmentations, no
nail or hair problems
3) Eyes: no redness, no squint
4) ENT: no rinohrea, no snoring, no ear discharge
5) CVS: no edema, no cyanosis
6) Respiratory system: no noisy breathing sounds, no cough
7) GI: abdominal pain, no diarrhea, no constipation, no
jaundice, stool normal color
8) Genitourinary: normal urine color, no frequency, no urgency
9) Neuromuscular: no convulsions, no headache, no joints
swellings or muscle pain

Past Medical History:

1. Antenatal: Good health of mother during pregnancy, she
visited pregnancy clinics regularly, U/S done and was normal,
no complications
2. Neonatal: GA 9 months, 3.7 kg, normal vaginal delivery

3. Postnatal: baby pink color, no cyanosis, no jaundice

4. Growth and development:
Walking at age of 1 year
Good social relationships with other children
Can tell stories
Can draw squares
5. Nutrition:
Breast fed until age of 6 months
Formula introduced at age of 6 months
Now he eating house hold foods
No history of supplements use
6. Past illness: no previous hospitalizations, no history of
chronic diseases, no surgical history
7. Drug history: free, no history of food or drug allergy
8. Immunization: EPI, no complications

Family History:
Father and mother are in good health, non
consanguineous
Has one sister, he is the 1st child in the family
No history of congenital heart diseases, no history of
congenital abnormalities, no history of allergy, no history
of blood disorders, no history of convulsive disorders, no
history of malignancies

Social History:

He lives in 1nd floor, well ventilated house

His father works in butchery , and he is smoker
Good economic status
No domestic animals

Physical Examination:
1. General appearance: patient looks well, oriented, conscious,
no cyanosis, no jaundice, no respiratory distress, rash
involving lower extremities, canula inserted into his left hand
2. Vital signs:
Temp: 37 C
Pulse: 76/min
RR: 24/min
BP:--3. Growth parameters:
Weight: 22 kg
above 50th percentile
Height: 110 cm
above 25th percentile
4. Eyes: no pallor, no jaundice
5. ENT: ears were not examined by otoscope but by inspection
there was no discharge, no redness, and no tenderness.
Tonsils pink not congested
6. Respiratory system:
Inspection: no tracheal tug, no nasal flaring, no
retractions, no cyanosis, no chest deformities, no visible
pulsation, no scars
Palpation: trachea is centralized, normal chest
expansion
Percussion: resonant
Auscultation: good air entry bilateral, no crackles, no
wheezing
7. CVS:
Inspection: no chest deformities, no visible pulsation, no
scars
Palpation: no thrills, no heaves, PMI (5th intercostal
space MCL)
Auscultation: no murmers, no added sounds
Pulse: 76/min
Capillary refill < 2 seconds

8. GI system:
Inspection: abdomen scaphiod, umbilicus centrally
located, normally inverted, no fullness and echomosis
on flanks, some spots of rash on suprapubic area and
flanks, no scars, no visible masses, no dilated veins, no
jaundice
Palpation: superficial palpation revealed tenderness all
over abdomen, no masses. Deep palpation revealed no
organomegaly, no masses
Percussion: Tympanic sound all over abdomen
Auscultation: absent bowel sound
9. Lower limbs: maculopapular rash involving lower extremities
starting from feet to buttocks, the rash not blanched by
pressure. The knee joints show no redness, no swelling, mild
tenderness upon movements

Summary:
Rami Maqboul a 1 year old patient came to hospital
complaining from abdominal pain and maculopapular rash
involving lower extremities and buttocks.

D.D:
HSP
JRA (still disease)