An infant with subacute fever and a skin lesion (Page 1/2)
| Prepared by... Virat Sirisanthana, MD |
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| Department
of Pediatrics, Chiang Mai University, Thailand |
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| 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) | ||||||
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| Investigations: | ||||||
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| What is the diagnosis? Next to Page 2 |