What Cause of Persistent Fever, Cough, and Worsening Rash?

February 13, 2012

This child presented with persistent fever, cough, and worsening rash of 5 days’ duration. The rash had spread to the neck, chest, back, and arms. What does this look like to you?


Case and photo courtesy of Ladan Modallel, MD,
Marita Sheehan, MD, and Golder Wilson, MD, PhD

This child presented with persistent fever, cough, and worsening rash of 5 days’ duration. On day 1, URI had been diagnosed and treated with nasal saline and acetaminophen. Secondary otitis media was treated with amoxicillin. At presentation, the rash had spread to the neck, chest, back, and arms, with fewer macules on the upper thighs and sparing of the lower limbs. Some hyperemia of the posterior palate, no exanthem; tonsils red and inflamed, no white plaques. WBC, 15,900/μL; hemoglobin, 11.3 g/dL; hematocrit 32.4%, with normal red cell indices. Bicarbonate, 17 mEq/L, with anion gap of 20 mEq/L; liver enzymes and alkaline phosphatase normal. What does this clinical picture look like to you?

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Case and photo courtesy of Ladan Modallel, MD,
Marita Sheehan, MD, and Golder Wilson, MD, PhD