An infant with subacute fever and a skin lesion (Page 1/2)

Prepared by...
Virat Sirisanthana, MD
Department of Pediatrics, Chiang Mai University, Thailand

 

A 8-month-old girl. Address: Chiang Mai, Thailand
Chief compliant: high fever for 8 days
 
Present illness:
> She had been well since birth.
> 21 days prior to admission, the family went to visit relatives at แม่สรวย เชียงราย and stayed there for 14 days.
> 12 days prior to admission, she developed a vesicular lesion at her left thigh.
> 8 days prior to admission, she developed fever. The lesion at her left thigh was crusted.
> 4 days prior to admission, she had an episode of mild cough and diarrhea. She was taken to a private clinic and had several medications. The cough and diarrhea subsided, but the fever markly increased.. Although she has been ill for more than a week, she is still active and has normal appitite.
Past history:
> She has had normal growth and development.
> Her immunization has been up-to-date.
 
Physical examination:
Body weight: 8.4 kg (50 percentile), Height: is at 90 percentile.
Vital signs: BT (axillary):40 degree celsius, PR: 160-140/mins, RR:60-48/min, BP 100/58 mmHg
General appearance: active febril infant
HEENT: normal
Heart: regular, Lungs: clear
Abdomen: liver 2.5 cm. below RCM, spleen 1.5 cm. below LCM, not tender , smooth surface
Neurological examination: with in normal limit
Lymph nodes: several left inguinal lymph nodes are palpable, diameter 0.5-0.75 cm.
Skin: an 1.5cm ulcer, surrounded by a red areolar and covered by a dark brown scab is seen at his left thigh (Figure 1 and 2)
 
Figure 1: An ulcer at left thigh
Figure 2: Close-up lesion
Investigations:
1.
CBC: Hb 10.9g/dL Hct 32.4mg% Wbc 33,300cells/cu.mm. (N 64% L 24% E 0.4% M 11%) platelet count 357,000 per cu.mm.
2.
U/A: WNL
What is the diagnosis? Next to Page 2


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