case_images: PMC9853421_01
case_images: Patient's lower extremities on presentation demonstrating edema and diffuse rash with scaly plaques and bullous areas.
case_images: fped-10-1083155-g002.jpg
case_images: PMC9853421_01_fped-10-1083155-g002.jpg
case_images: F2
case_images: A 6-month-old Caucasian male presented with 2 weeks of fussiness, fever, and decreased activity and one episode of hematochezia and hematemesis in the setting of 1 month of a progressively worsening rash that started in his diaper area and spread to the extremities, neck, and trunk (Figure 2). Physical examination on admission was remarkable for generalized edema (facial, periorbital, peripheral) with a diffuse, reddish-brown in color, serpiginous, rash with scaly plaques at his extremities and perineal area (Figure 2).
case_images: Patient's growth chart for weight from birth to present day with superimposed albumin values to highlight the impact of hypoalbuminemia on his falsely reassuring growth curve. Circle points indicate hospital system measurements, asterisk points indicate outside of hospital measurements. Albumin normal lab value range: 3.4-4.2 g/dl.
case_images: fped-10-1083155-g003.jpg
case_images: PMC9853421_01_fped-10-1083155-g003.jpg
case_images: F3
case_images: His length, however, dropped from the 73rd percentile at 2 months of age to less than 3rd percentile at presentation at 6 months of age (Figure 3). After diuresis, his weight dropped to the 4th percentile, which correlated with normalization of his albumin (Figure 3), indicating that the appearance of his reassuring growth prior to presentation was weight gain secondary to edema and not true growth.