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My 8 yrold daughter has had a cough now on and off for three…

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Hi doctorMy 8 yrold daughter...
Hi doctorMy 8 yrold daughter has had a cough now on and off for three months. It went away for 2/3wks after having it for two months and then came back. She has now had it, although it's sounding a little more chesty now, for four weeks, this time also accompanied by a low grade fever (under 37.5) and an outbreak of sore red marks on her knees and shins. They are sore to touch for a day or two and then fade away. The week the cough returned she got these red marks on her knees and shins, then they went away and she had no marks for a couple of weeks, but yesterday I saw some more of the same red marks on her arm. Sore to touch yesterday and are fading today. There has been no improvement in her cough either. It sounds chesty although she struggles to cough any phlegm up.Could you please help. What do you think we are dealing with?
Submitted: 8 months ago.Category: Pediatrics
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Answered in 1 hour by:
9/11/2017
Pediatrician: Doctor John MD, Doctor (non-pediatrics specialty) replied 8 months ago
Doctor John MD
Doctor John MD, Doctor (non-pediatrics specialty)
Category: Pediatrics
Satisfied Customers: 792
Experience: Medical Physician
Verified

Hello and welcome to JustAnswer.com

This is Dr. John and I will be helping you today.

I will be reviewing your question and will respond shortly.

I may need to ask a few more questions in order to best serve you.

Thank you for your patience.

Answers here are for education and information only.

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Pediatrician: Doctor John MD, Doctor (non-pediatrics specialty) replied 8 months ago

I do have a few more questions about your daughters symptoms, is that ok?

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Pediatrician: Doctor John MD, Doctor (non-pediatrics specialty) replied 8 months ago

Thank you for your response.

  1. Has she seen a doctor for either episodes of the coughing?
  2. Does she have a history of asthma?
  3. Does anyone else in the household have a similar rash?
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Customer reply replied 8 months ago
We have seen many doctors offer the period. At the moment she is on antibiotics in case it's some sort of bacterial bronchitis. We haven't seen any improvement in her cough though. She does not have a history of asthma. Nobody else in the house as the red marks. They are not raised at all. One doctor thought perhaps they were perhaps erythema nodosum?
Pediatrician: Doctor John MD, Doctor (non-pediatrics specialty) replied 8 months ago

good to hear that she has already seen someone. What antibiotic is she currently on?

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Customer reply replied 8 months ago
She is currently on augmentum
Pediatrician: Doctor John MD, Doctor (non-pediatrics specialty) replied 8 months ago

ok. If the cough is from a bacterial infection ,then augmentin is a very good choice. Although some coughs and lung infections are viral, which means antibiotics won't help and the infection has to run its course. Often times, the cough is the last symptom to go away, even after the infection is gone, because the lung tissue is still irritated from the infection and from the coughing.

As far as the rash, I agree that erythema nodosum is a possibility and that should also resolve on its own, but may take up to a month.

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Pediatrician: Doctor John MD, Doctor (non-pediatrics specialty) replied 8 months ago

Did my response fully answer your question?

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Customer reply replied 8 months ago
What would be causing the erythema nodosum? Why do you get them? Is it something to worry about? I don't like seeing them. What about microplasma pneumonia? Is there a chance of that? The augmentum doesn't seem to be doing much and the cough hasn't changed at all and I thought with a virus it would change?
Pediatrician: Doctor John MD, Doctor (non-pediatrics specialty) replied 8 months ago

Most cases of erythema nodosum are "idiopathic", which means no known cause. Infections are usually the cause of other cases of erythema nodosum. In rare cases, it can be caused by a problem with the immune system, and your doctor can do blood tests to check if it does not resolve.

As far as your question about mycoplasma pneumonia, that is a possibility and usually responds to a different antibiotic class (macrolides like Zithromax), so if she is not better after finishing the Augmentin, then I would recommend taking her back to the doctor for followup.

Does that answer your questions?

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Pediatrician: Doctor John MD, Doctor (non-pediatrics specialty) replied 8 months ago

If so,

I would like to thank you for your question and I hope you found my answer informative and helpful.

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You can always return and ask follow up questions if needed.

- Dr John.

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Customer reply replied 8 months ago
How common is it for children to get erythema nodosum?
Pediatrician: Doctor John MD, Doctor (non-pediatrics specialty) replied 8 months ago

Most studies on it give an incidence of between 1 to 5 in every 100,000, so not extremely common as with other rashes in children (viral exathems for example) but they do occur in this age group.

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Customer reply replied 8 months ago
You said in rare cases it could be a problem with the immune system. What would this be? And would there be other signs if this was the case?
Pediatrician: Doctor John MD, Doctor (non-pediatrics specialty) replied 8 months ago

usually the auto-immune issues are seen in adults, so would be very unlikely that your daughter's rash would be due to that problem, but if the rash continues, then there is some blood work that her doctor can do to see if there is an issue with the immune system.

Her rash can possibly be due to insect bites as well (mosquitoes or beg bugs) but its difficult to see on the picture.

I would recommend follow up with her doctor if the symptoms are not better after the antibiotics and they can continue to direct her care.

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Pediatrician: Doctor John MD, Doctor (non-pediatrics specialty) replied 8 months ago

Does that help?

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Customer reply replied 8 months ago
No they are definitely not bites, they are not raised and they appear to be coming from the inside. Have you heard of EN being associated with mycoplasma by any chance?
Pediatrician: Doctor John MD, Doctor (non-pediatrics specialty) replied 8 months ago

EN can be associated with many different types of infections (its not specific to a certain infection). Its due to inflammatory response in the body that occurs when the body is fighting of an infection.

Its more of a side effect that a true disease, so would focus on getting her cough better and would expect that the skin lesions will resolve on their own.

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Pediatrician: Doctor John MD, Doctor (non-pediatrics specialty) replied 8 months ago

Does that make sense?

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Pediatrician: Doctor John MD, Doctor (non-pediatrics specialty) replied 8 months ago

If she isn't getting better, you can request to see a specialist, such as a pulmonologist (lung specialist) and a dermatologist (skin specialist) and they can also help getting a diagnosis.

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