Case 239


A 7 year-old female patient reports mild abdominal pain, diffuse type, with abrupt onset and spontaneous resolution. After 24 hours, there were petechiae and bruising in the lower limbs (Image 1), besides signs of arthritis in the ankles (Image 2) and knees, with no other abnormalities on physical examination. In use of Amoxicillin for the treatment of acute otitis media for 2 days. Laboratory tests showed C-reactive protein and elevated rate of erythrocyte sedimentation; Complete Blood Count (CBC) and urine tests without changes.

Inner face photograph of the left leg in abduction. Those lesions do not disappear on digital pressure.


Photograph of the left tibiotarsal joint. Inner view, at the height of the medial malleolus.

Considering the clinical history and the images presented, which is the most likely diagnosis?

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