Key Features of the Physical Examination

DiagnosisRash Characteristics and DistributionOther Relevant Physical Findings
Immune thrombocytopenic purpuraSoft tissue bruisingOral mucosal bleeding
Numerous diffuse petechiae with scattered purpuraAbsent splenomegaly
Henoch-Schonlein purpuraRaised “palpable” petechiae with some coalescence to purpura, often from waist downAbdominal tenderness
Scrotal swelling
Edema of the joint areas/extremities especially of the ankles and knees
Papular-purpuric gloves and stockings syndrome caused by parvovirus B19Stocking and glove distribution of petechiae, often with sharp demarcationRash involves the genitalia and circumoral areas
Cervical lymphadenopathy
Rickettsial diseaseAcral distributionChild may appear unwell or have nuchal rigidity
Macular/maculopapular component
Palm and sole involvement
Petechiae may be fewer in number
MeningococcemiaPetechiae and purpura may be present, distribution often lower extremities if still well appearingChild may appear unwell or mildly tachycardic
Leukemia or other hematologic malignancyNonspecific distribution of petechiae or purpuraPossible hepatosplenomegaly, mucosal bleeding, or lymphadenopathy