PEMPix is the American Academy of Pediatrics Section on Emergency Medicine’s visual diagnosis competition. It is held annually at the National Conference and Exhibition. This year, all ten finalists will be posted online on and at, one a day with voting opening to AAP Section on Emergency Medicine members thereafter. I hope you enjoy this online-only format, and hope that it will serve to highlight some of the fantastic learning cases that our colleagues submitted this year. It was again very difficult for the panel of judges to select the finalists and I could not have done it without their assistance. As a special treat I’ve included a musical selection form the 1980s as an optional “hint,” and to serve as a soundtrack for your learning.

This PEMPix case was submitted by:

Blake Gruenberg, MD, Pediatric Emergency Medicine Fellow and Daisy Ciener MD, MS, Assistant Professor of Pediatrics from the Vanderbilt University Divison of Pediatric Emergency Medicine

His urine is red and he has a rash


A 13 year old male presented to the Emergency Department with red urine, hives, facial swelling and difficulty breathing. His medical history is significant for an almond allergy, which caused rash but not anaphylax