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JAMA Pediatrics Clinical Challenge
October 2016

A 7-Year-Old Girl With Periorbital Edema, Ecchymosis, and Conjunctival Hemorrhage

Author Affiliations
  • 1Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston
  • 2Section of Infectious Diseases, Baylor College of Medicine, Texas Children’s Hospital, Houston
JAMA Pediatr. 2016;170(10):1021-1022. doi:10.1001/jamapediatrics.2016.0134

A previously healthy 7-year-old girl presented with fever, sore throat, bilateral conjunctival hemorrhage, periorbital edema, and eyelid ecchymoses (Figure). The illness began 1 week prior with low-grade fever and back pain. The following day, she developed periorbital swelling and subjective high fever. The back pain resolved, but she complained of fatigue, stiffness in her limbs, and sore throat. A rapid antigen detection test from a throat swab was positive for group A Streptococcus, so she was given an “antibiotic shot,” presumably penicillin. She developed a mild cough and had several episodes of vomiting and diarrhea. She presented for reevaluation when she developed eyelid ecchymoses and conjunctival hemorrhage. Four days prior to the onset of illness, she had completed a 10-day course of amoxicillin for acute otitis media.

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