A 9-year-old girl with no relevant past medical history presented with a pruritic rash with small papulo-eritematous lesions that in some areas become confluous palms and palms.
There was no enanthema and the patient was afflicted.
The patient reported having been taking amoxicillin for 9 days due to LII pneumonia diagnosed in the reference hospital.
The differential diagnosis is initially made with: Micoplasma pneumoniae infection, viral exanthema (probable infectious mononucleosis), drug allergy to amoxicillin and toxicodermia.
The clinical picture of the patient decided to suspend antibiotic treatment, an antihistamine was prescribed to calm the pruritus and a blood test was requested.
The results of the first laboratory tests were: ESR 31; Hb 14.1 g/dl; Hto 41; leukocytes 8.200 (N 44.7%; L 42.1%; M 9.3%; Eplasma IgG 2204; platelets 564.000
After this first laboratory test, she takes more the possible viral etiology, probably a monoxonucleic syndrome GL negative, and at 2 weeks a control analytical is performed with the following results: GOT 130 positive Paul IgM/L IgG; GPT negative
Arrived at this point, it was decided to repeat the analytical one month later, expanding the study and ruling out the most frequent causes of transaminitis.
The results were: GOT 228 U/L; GPT 483U/L; GGT 257U/L; CPK 87 U/L; alpha-1-antripsin 147 mcg/dl negative antinuclear antibody serology 43 mcg/dl
After this analytical suspicion focuses on Wilson's disease.
To complete the study copper was requested in urine, with the result of 170 mcg/24 h (normal: 0-60) and liver ultrasound showing mild steatosis.
With the suspicion of dengue, the patient was referred to the pediatric hepatology unit of a referral hospital where they confirmed the diagnosis and started treatment with D-penicillosis Wilson.
