Fever with rash in a 1-year-old boy (Page 1/1)
Prepared by...
Virat Sirisanthana, M.D.
Department of Pediatrics, Chiang Mai University
 
CC:  A 14-month-old boy was admitted because of fever and rash for one day.
PI: He was a healthy boy prior to this admission. Two days prior to admission he had acute onset
of high fever. One day prior to admission the exanthematous rash appeared in the axillae, groin,
and neck and became generalized with in 24 hours. The rash was not itching. Although he had
high intermittent fever his activity and appetite were normal. His mother denied any URI symptoms.
 
PE: Positive physical examinations on the first few days of admission included:
1.
body temperature of 37-40 C (intermittent fever).

2.

The exanthem was red, finely papular, and blanched on pressure. The rash had the texture of coarse sandpaper. The cheeks appear flushed, and the area around the mouth is pale (circumoral pallor) as in figure1 and 2.
 
Significant negative physical examinations included:
1.
No pharygitis nor tonsillitis.

2.

No edematous nor reddened tongue.
3.
No conjunctivitis
   
Figure 1
Figure 2
rash-face.jpg (23509 bytes) rash-leg1.jpg (20016 bytes)
 
Laboratory investigations:
CBC: Hb 10 mg, Hct 32%, WBC 7,300 (N 32%, M 10%, L 46%, AL 9%, E3%),
platelet count 200,000
UA: WNL. Hemoculture and Urine culture were sent.
 
Course in the hospital:
The intermittent fever and rash persisted for 6 days and subsided after there was the discharge
coming out from his left ear. He was then started on oral erythromycin. Desquamation began
soon after subsiding of the fever as shown in figure 3 and 4. When he was discharged, there was
no abnormal physical finding, except for the peeling of his skin.
Figure 3
Figure 4
desq-1.jpg (22265 bytes)
desq-2.jpg (22673 bytes)
 
Diagnosis: Scarlet fever.
Further Reading: Scarlet fever in :Nelson WE, Behrman RE, Kliegman RM, Arvin AM. eds.
Textbook of Pediatrics 15th ed. W.B. Saunders Company, 1996.


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