Coincidental GI and Skin Symptoms in Child

Hi-

I posted a few months ago and received great help from the doctor as well as other posters.  I am hoping I can get further assistance, as my daughter's condition is still confusing me.

My daughter is almost 3 years old, and has been suffering from serious constipation (presumably due to stool witholding resulting from an anal fissure) since she was 18 months old.  Her GI has never felt anything other than abdominal x-rays were necessary for diagnosis/treatment.  She had three x-rays total which showed progressive improvement after a "total clearing" program of enemas, Dulcolax suppositories and oral laxatives.  After many medications, we have found Miralax 10 grams daily to be a near perfect solution for her.

She has perfectly normal bowel habits for weeks at a time, but inexplicably begins soiling every 3-5 weeks or so.  When she has the soiling, she is apparently in some sort of pain, because she is uncharacteristically fussy for the 36-48 hours the bout lasts.  In a P.S. in my first post, I mentioned she breaks out in a rash at times.  The doctor suggested Henoch-Schonlein Purpura as a possibility, and others suggested IBS or Crohn's.  I have been keeping a written diary of her symptoms and the rash preceeds the constipation by about 24 hours 100% of the time.  I have spoken with her GI by phone about it.  He said he does not feel that it is Henoch-Schonlein because it has been occurring intermittently since September of last year, and that Henoch-Schonlein wouldn't have lasted this long.  He also thinks since it is only occasional and that generally she's doing very well that there's no need to go on a "fishing expedition", since the rash is likely a complete coincidence.

The rash occurs mainly across her lower back, buttocks, and sometimes on the upper thigh.  It begins as tiny red dots on the skin, and changes within 12 hours or so to large (half inch or larger), red, pimple-like spots. I have heard chickenpox lesions described as a "dewdrops on rose petals" and that's exactly what this looks like.  The spots fade in a few days to very dark purple/brown marks.  They do not seem to itch.  She tells me they do not hurt, but when I "secretly" touch one, she is irritated.  Her pediatrician said it looked like folliculitis.  She has never been in a hot tub, but I do think she sweats more than other kids her age.

My biggest concern is that her last outbreak of these spots was significantly worse than any we've seen thus far, with about 20 of these spots.  I am mildly concerned about scarring, but am more concerned that the rash is a symptom of some issue that needs to be addressed.

Any detailed description of the skin lesions that occur with Crohn's, IBS, and especially Henoch-Schonlein Purpura would be GREATLY appreciated.  I am wondering if the description of her rash strikes a chord with anyone.  I am also fully open to the fact that this may indeed be an amazing coincidence!

Thank you so much for any advice!!

[Kevin Pho, MD]

Here is a description of the rash from UptoDate:
"The rash in HSP is typically purpuric (with normal clotting studies) and distributed symmetrically over the lower legs and arms. In children, however, the rash may initially be urticarial and associated with local edema."

Here is another description from American Family Physician:
"The rash looks like small bruises or small reddish-purple spots. It's usually on the buttocks, around the elbows and on the legs."

Some pictures of HSP can be found here:
http://images.google.com/images?hl=en&ie=UTF-8&oe=UTF-8&q=henoch+schonlein+purpura&spell=1

I would consider a second opinion.  A dermatology referral can be considered to biopsy the rash to give a more definitive diagnosis.  I would also obtain another opinion to completely exclude the possibility of HSP before attributing the rash to a coincidence.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

[lil sunshine]

My 10 yr old daughter has had the bowel issues, they have resolved to the effect that she has a BM about every 3-4 days. I didn't know this , dr asked. She has had the rash on her back and chest for yrs. I was told Folliculitus (folliculitis) then acne. I was thinking Strep{scarlet fever} as it tended to coincide with her Best friend getting Strep throat. Mary has never had ST! She does have daily headaches, not migraines and has a spinal fluid buildup, pseudotumor cererbri is the diagnosis. She also started developing breasts at 7 and has already had her pereiod since she turned 10 {DOB )06/93. Endo did bone age and put her at 13-14 yrs old. She is above/off the charts for height and Head circumference. Her weight is around 90% but she is so tall it makes her appear thinner.
She is being evaluated for neurofibromatosis. As of now she still only meets the Cafe Au lait criteria. Although she does have mild scoliosis and unexplained stress fractures in feet /ankles and bone/ leg pain with no obvious reason. Has been checked for thyroid I have Hashimotos, Lupus, a maternal uncle and lymes all neg  so far
Bonnie

[yoshi]

does her stool smell??
i mean smell different.

[truman]

Yoshi, I'm not sure if you're asking if there's been a change in smells, or if it just smells different than normal stool.  There has not been a change in odor in about a year, but her stool is HORRIBLE smelling.  It smells significantly worse than "normal" stool does.  Several family members cannot change her diaper because they cannot tolerate the smell.  It is truly awful!

Bonnie, I am sorry to hear about your daughter...is she seeing a GI too?

[lil sunshine]

No mary isn't seeing a gi dr, only endo, neuro, dermatology and opthomalogy. Not to mention ortho as well as allergy. She has to have a spinal tap as well as more MRIs.
Good Luck to your daughter,
Bonnie

[PAJ]

I remember I responded to you on you last post , I made the connection with Autism and the spots you describe around the anus. You replied saying that your child wasn

[yoshi]

you addressed several posters in your last posting.
none of us have posted that doc said we have yeast infection??
the author never said her child is autistic??
on the smell of stool,i do know if we eat seafood which contains sulphur,the stool will smell different.

[yoshi]

what is diving ban??
asians eat a lot of bean curd(tofu) and if they are not fresh,it ferments .
but i am not sure if japanese has more yeast infection than others due to tofu or is it the raw fish and other sea organism they consume which may contain bacteria??

[lil sunshine]

I will have to say that my daughter , even with pseudotumor and other health problems is NOT autistic. She is basically a straight A student with a B every once in awhile. There is a paternal family history of Fragile X which is being looked into to see if Mary is a carrier, which would in turn affect her children.  She doesn't really have a bowel problem or urinary eirther, although she had frequent UTIs as a toddler.
Bonnie

[nurse12hr]

I am really intrigued by the description later in this article about the skin "nodules" (erythema nodosum) mentioned.  Does she run a fever (might explain the crankiness?) or have joint pain, too?  

good luck with your search for the answer.  I would personally take her for another opinion.  Please let us know what happens!


Crohn's Disease
(Original description by Dr. Crohn in 1932. Characterized by a chronic and long lasting ulceration of a section or sections of the digestive tract. Most commonly, it occurs in the lowest portion of the small intestine (ileum..where B12 should be absorbed) and the large intestine. The ulceration affects the full thickness of the intestinal wall, through all layers of the intestinal wall and involves the entire digestive system, from the mouth to the anus, as well as the adjacent lymph nodes. The inflamed parts heal, leaving scar tissue that narrows the passageway. Flare-ups can be mild or severe, brief or prolonged. The inflammation tends to reoccur in the same areas of the colon and when the area is surgically removed (not a cure, just temporarily relieving symptoms), Inflammation will strike another area.

Crohn's disease is similar to ulcerative colitis in many respects. Both involve loss of appetite, abdominal pain, general malaise, weight loss, diarrhea and rectal bleeding. The primary difference between the two conditions is the degree of involvement of the wall of the intestine. Ulcerative colitis is limited to the mucosa and submucosa (first two layers of the wall). Crohn's disease also involves the next two layers, the muscular layer and the connective tissue layer below it.

Its cause is uncertain but:

[PAJ]

Sorry ,bit too rushed that post

[yoshi]

paj,
often on this board and in doctor office,doctors dont seem to take into consideration that patients can have a case of yeast infection ,especially after taking antibiotics .
i am just reporting in my last visit with my doc,he acknowledge that it is possible to have yeast infection if a person has taken prev pac,at 200 dollar per visit,patient and doctor do indulge in general topic of interest.
i am giving my doc the credit where credit is due/
sorry to disappoint you,my doc did not diagnose me with yeast infection,he mentioned possibility of cancer .

[yoshi]

if stool smells real bad,have you take a sample to the lab??
i wonder if there is something a baby can contract in the hospital?someone was talking about c diff and that spores of c diff is usually contracted in hospital,as hospital is a place you find plenty of germs.

[kimbacat]

Erythema Nodosum nodules are painful.  they usually occur on the legs, sometimes arms.  they are firm, raised lumps and are an inch in diameter or larger.  mine looked like big bruised spots.  trust me, they really, really hurt.

[kwag]

Thanks to you again.  As usual, you are right on the money.  It is so hard to look at illness in a different way than we are taught all our lives.  Keep up the info sharing.

[PAJ]

Thanks Kwag , I can tell you I

[Caroline5]

Stop with the yeast already. It is getting old.

[DB47]

A comment on the mention of autism, to clarify that, if possible:

Autism is a group of syndromes, of which Fragile X is but one.
A good place to learn about them is:
http://www.isn.net/~jypsy/sitemap.htm

There you can check out Fragile X and Asperger's Syndromes, along with many others, all part of the autistic spectrum.

If your kid is doing well academically, check Asperger's Syndrome, that may cause some of the symtoms (symptoms) you indicate your kid has and, because is one of the less outwardly obvious of the autistic syndromes, is often not thought of, even if it affects in one manner or another, best it can be measured, from one in 250 to 500 people.
Many of the stories of kids with Aspergers, that seem similar to what you mention ails your kid, are found in the OASIS forums of the Asperger's association at:
http://www.aspergersyndrome.org/

This is but yet another long shot to check out.
Remember that, when doing so, we tend to try to make the disease fit the symptoms.
That is how diagnoses are made, but without a doctor's education, laymen can be sure something fit and be wrong.

Maybe this will be the key to what is happening with your kid and then, it may be another blind alley.