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Real Doctors (Life Makers)  |  Clinical  |  Pediatrics  |  Case discussion  |  A 22 month year old boy with fever and a rash « previous next »
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cleo_md
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A 22 month year old boy with fever and a rash
« on: /October/ 30, 2005, 04:14:24 PM »

A 22-month-old boy was brought to the urgent care clinic by his mother because of a fever and rash. The symptoms had begun the day before presentation when the rash started on his stomach. He had had a runny nose but no cough. No siblings were ill, but he attended a day-care facility, and his mother noted he may have been exposed to an illness there.

The child had been in good general health. The records from his regular pediatrician were not available, but the mother noted he had had no medical problems, and his growth had been normal. She believed his immunizations were up to date, but she did not have a copy of his immunization record available. He had not had any similar illness before (with a rash) but had had minor colds.

On examination, the child had a temperature of 38.6?C (101.5?F). He was alert and did not appear to be in any acute distress. He had a vesicular rash on his trunk and back with an estimated 30 lesions; several lesions were on his neck, and several were on his face. He had a small number of lesions on his extremities. Most lesions appeared as 3- to 4-mm erythematous papules with a small central vesicle. He had mild rhinorrhea with clear drainage. The remainder of the examination results were normal, including normal appearance of the tympanic membranes, normal mucosal membranes, and normal auscultation of the lungs.


What illnesses can present with these symptoms?

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3abeer
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Re: A 22 month year old boy with fever and a rash
« Reply #1 on: /December/ 07, 2005, 06:28:02 AM »

dear cleo:
kefk, i miss u
i think this kid has chicken box,
other differential diagnosis would be cosxacievirus infection, but this woul be more localized  bom
what is ur answer cleo  Grin
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musheera
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Re: A 22 month year old boy with fever and a rash
« Reply #2 on: /December/ 07, 2005, 10:48:23 PM »

I think it's chicken pox
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dr_b.e.s.m
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Re: A 22 month year old boy with fever and a rash
« Reply #3 on: /December/ 08, 2005, 04:52:44 AM »

yea, I think it's chicken pox too.

vesicular rash starting on the trunk and the prodrome is mild and started one day before the onset of rash.


DD can be any fever with rash eg measles , rubella , erythema infectiosum ,all cause maculopapular rash while coxsakie virus causes vesicular rash (like that of chicken pox).

I know 2 conditions caused by coxsakie virus : Herpangina (vesicles on tonsils and palate leading to dysphagia) and Hand foot & mouth disease ( oral uslers + vesicles on hand and foot)

« Last Edit: /December/ 08, 2005, 05:02:39 AM by dr_b.e.s.m » Logged
 
cleo_md
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Re: A 22 month year old boy with fever and a rash
« Reply #4 on: /December/ 12, 2005, 06:54:06 PM »

Excellent !

Here's the full answer

Many viral illnesses in childhood are associated with rashes. Acute rashes can be roughly divided into maculopapular rashes and papulovesicular rashes (as this patient has). Maculopapular rashes are associated with measles, rubella, cytomegalovirus infection, roseola, miliaria, erythema infectiosum, and scarlet fever. Other less commonly seen cause of maculopapular rash include meningococcus infection, toxoplasmosis, Rocky Mountain spotted fever (and other tick-borne fevers), mononucleosis, and Kawasaki disease.

Vesiculopapular eruptions can occur with chickenpox and shingles (herpes zoster), Coxsackie virus, herpes simplex (eczema herpeticum), enterovirus infection, impetigo, molluscum contagiosum, smallpox, and insect bites. Inflammatory skin conditions, such as eczema, can also result in a vesicular rash.

As can be noted from the list, a rash can result from something as benign as chigger bites obtained during play outdoors to life-threatening meningococcemia. In addition, many other causes of a rash exist, such as drug reactions, allergic reactions, heat and sun exposure, and skin disorders, which may occur concurrently with another illness. This makes it important to take into account the presentation of the child and the history.

In this child, smallpox is unlikely, mainly because it is not endemic but also because his illness pattern is not consistent with smallpox. Persons with smallpox present with a prodromal illness with headache, myalgias, and fever for several days before the rash erupts.

Symptoms of measles include a maculopapular rash, though the lesions may become crusted. Measles is usually preceded by several days of fever, conjunctivitis, and rhinorrhea, and the rash typically begins on the face first and then progresses to the trunk and gradually becomes confluent. An atypical measles rash may develop urticarial and purpuric lesions on the extremities, and these may at times be vesicular.

Eczema herpeticum has a concentration of vesicles in eczematous areas. Herpes zoster has a characteristic distribution along dermatomal zones. Symptoms of impetigo include vesiculation; however, the rash is usually in areas that are scratched, such as the nose, and it is not typically associated with systemic symptoms. Insect bites will have a distribution that is consistent with exposure (eg, on the lower legs), and generally they have no associated systemic symptoms. Enterovirus usually causes a maculopapular rash, though hand-foot-and-mouth disease can cause mouth lesions and vesicular lesions in a peripheral distribution (the trunk is spared).

Although other illnesses may be considered as well, the combination of an abrupt onset of vesiculopapular rash and fever together, with the rash starting on the trunk and then spreading to the extremities, suggests primary varicella (chickenpox).
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dr_b.e.s.m
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Re: A 22 month year old boy with fever and a rash
« Reply #5 on: /December/ 13, 2005, 04:18:36 PM »


Vesicular lesions with erythematous margins --->? Chickenpox








Numerous blisters and scabs erupt on the face or elsewhere, associated with swollen lymph glands and fever (in patients with atopic dermatitis) -----> Eczema herpeticum












painful mouth ulcers causing difficulty in swallowing


A painless rash or vesicles may also develop over the palms, soles and sometimes buttocks ----> Hand, Foot and Mouth Disease
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3abeer
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Re: A 22 month year old boy with fever and a rash
« Reply #6 on: /December/ 14, 2005, 07:27:50 AM »

SALAM GUYS ;
RU PLANNING 2 GO 4 PEDIATRICS?
بديت أخاف على مستقبلي من المستوى اللي أنا شايفاه  fine

great effort, may ALLAH bless all of u  clapping
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cleo_md
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Re: A 22 month year old boy with fever and a rash
« Reply #7 on: /December/ 14, 2005, 05:11:11 PM »

3abeer dearest , I am just your delegate here when you are away! Smiley
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3abeer
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Re: A 22 month year old boy with fever and a rash
« Reply #8 on: /December/ 17, 2005, 02:57:01 AM »

dear cleo & all colleagues ,
its my pleasure to work with such distinguished drs like u

ALL IN MIZAN INSHALLA  clapping
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