An 18-month-old girl with fever and vesiculopapular rash (Page 1/2)

Prepared by...
Kakanang Jantarapagdee, M.D.
Virat Sirisanthana, M.D.
Department of Pediatrics, Chiang Mai University, Thailand
An 18-month-old girl. Address: Chiang Mai, Thailand
Chief compliant: Vesiculopapular lesions at both palms and soles for 2 days
Present illness:
> She had been well since birth.
> 5 days prior to admission, She developed low grade fever, dry cough and running nose.
> 2 days prior to admission, low grade fever persisted and she developed vesiculopapular lesions at both palms and soles
> 1 day prior to admission, although the fever subsided, the skin lesions increased in number. There is no pain nor iching.
Past history:
> She has had normal growth and development.
> Her immunization has been up-to-date.
Vital sign : BT 37.5 c PR 100 / min RR 40 / min BP 65/40 mmHg
GA : normal conscious , alert
HEENT : no pale conjunctiva , no icteric sclera , yellow ulcers surrounded by red halos on the labial and buccal mucosal surfaces, on the tongue, palate, uvula, anterior tonsillar pillars, and gums.
Lymph nodes: no LN enlargement
Heart : normal S1 S2 , no murmur
Lung: clear both lung
Abdomen: soft , not tender , no hepatosplenomegaly
Extremity : normal movement , multiple thick-walled grey vesicles with an erythematous base lesions on both palms and soles
Genitalia : no lesion
Physical examination:
General appearance: An active fully concious girl
Body weight: 9.5 kg (50 percentile), Height: is at 50 percentile
Vital signs: BT :37.5 degree celsius, PR: 100/mins, RR:36/min, BP 65/40 mmHg
HEENT: no pale conjunctiva , no icteric sclera , multiple vesicular lesions on erythematous bases at the mucosa in the oral cavity, including tongue (figure 1)
Lymph nodes: no enlargement
Chest: Heart: normal S1 S2 , no murmur, Lungs: clear
Abdomen: soft, no hepatosplenomegaly
Extremities : multiple vesiculopapular lesions on erythematous base on both palms and soles (figure 2,3)
Neurological examination: with in normal limit
Skin: few papular lesions at both wrists, spreading from palms (figure 2)
Figure 1: multiple yellow ulcers surrounded by red halos on the tongue
Figure 2: Thick-walled grey vesicles with an erythematous base.lesions on a palm
Figure 3: Thick-walled grey vesicles with an erythematous base.lesionslesions on palms and sole
Problem list:
> Low grade fever
> Vesiculopapular lesions at both palms, soles and in the oral cavity

What is the diagnosis? Next to Page 2


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