Purpuric Palmar Macule in a Child With Fever of Unknown Origin

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Abstract
REPORT OF A CASE A 14-year-old white boy was admitted to the hospital with fever of unknown origin, anemia, and renal failure. At the age of 2 months, he had undergone a valvuloplasty for congenital aortic stenosis. He remained healthy until the onset of low-grade fever and upper respiratory tract infection 2 months before admission. Despite two courses of antibiotics, the fever persisted and renal failure developed. The physical examination revealed a chronically ill-appearing boy with fever, systolic and diastolic heart murmurs, and marked hepatosplenomegaly. Laboratory examination disclosed the following values or results: hematocrit, 0.14; erythrocyte sedimentation rate (Westergren method), 103 mm/h; leukocyte count, 2.3 × 109/L; platelet count, 120 × 109/L; serum urea nitrogen, 18.2 mmol/L; creatinine, 495 p-mo/L; creatinine clearance, 0.17 mL/s; soluble immune complexes, 20.26 p.gEq/mL (normal, 0 to 4 p,gEq/mL); chest roentgenogram, cardiomegaly; and six blood cultures, antinuclear antibody, antibody titers for the human immunodeficiency virus, and purified protein derivative skin test, normal or negative.