The Worst Rash....Erythema Multiforme, An Amoxicillin Drug Reaction

We've been so lucky to have healthy children.  Kyle joked after this exhausting week that all of our children have now been to the hospital twice, except for Vincent, who we would all agree is the most likely to end up in a cast!  He's never been!

This week our daughter Olivia spent two days at Kosair Children's Hospital after she had a horrible drug reaction to amoxicillin. 

The story began at her well-check up.  She was behind on her shots, so the nurse practitioner gave her 3 vaccines plus the flu shot.  (4 in all).  During her examination, the nurse asked me if I thought Olivia had an ear infection.  I said no.  She had not had a fever or runny nose, symptoms I associate with an ear infection.  The nurse proclaimed that her ear was pink, probably not due to the fact that she was screaming, and prescribed her amoxicillin.

All was fine until her 8th day on the medication.  On Thursday, after dinner I noticed she had hives.  This was not her first case of hives.  Over the summer she had a case of hives that lasted about a week.  We took her to the doctor but could not determine a cause.  I tried to think of possible causes...was it the frozen sweet potatoes she ate?  Nothing else was new.  I gave her benadryl and put her to bed, assuming they'd be gone by morning.

Friday morning, I noticed that the hives were worse and they didn't seem like typical hives.  They were bruising.  I called in a sick day to work.  She couldn't go to daycare with bruises and hives.  She was acting fine, but the bruises had me worried.  I started to google "hives and bruising".  Of course you get all sorts of nasty diagnoses, which is no comfort!  So, I took her to the pediatrician.

The nurses told me that it was the worst case of hives they had seen.    The hives were large, bright red and would bruise in the center.  The didn't seem to itch so she seemed perfectly content!  It just looked bad.  The doctor said they'd be gone by Monday.  She gave me a doctor's note, just in case.  She could return to daycare.  I was to double her benedryl dose, every 4 hours.

Saturday morning I could tell Olivia wasn't feeling good.  The hives looked worse.  Her stomach looked a bit swollen around her belly button.  I took her to our neighbor, Heather that works at Kosair Childrens Hospital.  She said she had never seen hives that bruised like that.  That made me worry even more!  After all, she worked in a children's hospital!  Surely she's seen everything!  Olivia was covered in hives and bruises at this point.  Heather took Olivias temp and it was 102.  Heather recommended that I take her to Kosair at Brownsboro.  They are an outpatient children's hospital.  She thought that they might send Oliva downtown to be admitted but wasn't sure.  So we went.

At Brownsboro, Olivia saw a nurse practitioner that diagnosed her with HSP, Henoch-Schloein Purpura.  It was odd, because at first she seemed to think it was Erythema Multiforme, but at the last minute she changed her diagnosis.  Olivia's blood work came back perfect.  With HSP, kidney damage can occur, so the nurses main worry was kidney problems.  She said since her blood work was perfect we didn't need to be admitted and she sent us home with no treatment.

We took Olivia home and gave her oatmeal baths.  Her rash seemed to be getting better.  The bruising was fading.  It was 2 days after the hives had started.  I was more relieved now.  The nurse didn't seemed worried and as long as her fever was down she seemed fine.

Other erythema symptoms are
Red hands and feet and 
Large targets, as the doctors later called them.














On Sunday, Olivia's belly looked great, but now the hives had spread even more to her back, arms, legs and face.  Around nap time I started to notice that her arms seemed tight.  She was swelling.  I asked Heather to come over to look at her.  She agreed but said she was ok.  The rash was looking better.  She'd check on her again later.  At 6pm, I took the kids to cross country practice.  Olivia looked swollen.  I started getting emotional when I was telling my friend April about it, and then when I got home from practice I could tell Olivia had swollen even more.  I asked Heather to come look at her again.  Her skin was tight and it hurt her to touch her legs.  She jumped when you touched her legs.  Her feet were a bluish color from bruising.  Heather said take her in to Kosair downtown.

Downtown Olivia was diagnosed with Erythema mulitforme.  She was slightly dehydrated.  She hadn't wet a diaper since lunch-time.  All her fluids seemed to be going to her arms, legs and face.  They couldn't put in an IV in triage, even after calling in the IV team.  Her arms and feet were too swollen to find a vein.  She was admitted.  When we walked to her room, I noticed 4west on the door...that's the unit where Heather worked!  Her resting heart rate was 170-180.  If she moved or turned it would go higher, several times setting off the heart monitor when it would go over 200.  The alarms were nerve wracking!  They weren't sure why her heart rate was so high.  I could feel her chest pounding like she just had sprinted a 400 and she was only sleeping!  Fluid caused her to have a heart mumur so they ordered a echo on her heart.  I couldn't even watch the screen.  Her heart was beating so fast it looked painful!  We sat in a chair and she slept in my arms for 2 days.  The crib was a place of torture so she wasn't about to sleep in there. She was given 2 IV's of fluid to help with dehydration and to flush her system. Other than that it was a wait and see. 

Olivia and her baby!

After two days she started to feel better and gobbled down some yummy white chili!

 By Tuesday we were able to return home!  Even though her face was still a bit puffy, she was feeling great!  The kids were so excited that we were all home!  Isabella wasn't sure that Olivia remembered her!  "Is that our baby", she asked???  "It looks like they rearranged her face!"  But by Wednesday she had barely a hive!  And by Thursday her fever was gone too!

It was a scary experience that made us very thankful for healthy children.  I could barely eat for 5 days and slept about 4 hours in 48 hours.  I can't fathom having a chronically sick child or a child with a life threatening condition.  You try not to imagine the worst, but then you do.  I thank God that we were able to bring her home healthy and from now on I will be sure to ask more questions of our pediatrician.  I definitely believe that antibiotics are over prescribed.  Most likely she would have been fine without that amoxicillin.  Between the antibiotic and the vaccines, was her immune system overloaded?  The docs wouldn't give me a clear answer on that one.