Figure 1
Figure 2
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Prepared by...
Virat Sirisanthana, M.D. |
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Department of Pediatrics,
Chiang Mai University
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CC: A 14-month-old
boy was admitted because of fever and rash for one day.
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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: | |
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1.
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body temperature of 37-40 C (intermittent fever). |
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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: | |
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1.
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No pharygitis
nor tonsillitis.
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2. |
No edematous
nor reddened tongue.
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3.
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No conjunctivitis
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Figure 1
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Figure 2
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| 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. |
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Figure 3
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Figure 4
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| 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. |