Fever and Rash - NCC Pediatrics Residency



Fever and Rash

You are stationed at Ft. Bragg, NC. A 9-year old boy presents to the Emergency Department in October with a CC of fever.

He was well until 2 days ago when he began to feel a little achy. He felt warm but had no fever. Overnight he developed a mild headache which intensified over the day, with some relief with ibuprofen. He had a low-grade fever which also seemed to respond to ibuprofen. He rested indoors all day and went to bed early.

When he awoke he was febrile, had a worse headache, and his mother noted a rash on his arms and took him to the ED.

FHx: unremarkable

PMHx: unremarkable

SHx: lives with parents, younger sister. A/B student. Spends lots of time outdoors, enjoys fishing. No known recent tick bites- mom recalls taking ticks off of him in the summer a few times.

ROS: HA, mild photophobia (prefers a darkened room due to his HA), no neck stiffness, no cough, heart complaints; mild nausea with HA, no V/D. Rash noted on arms and legs- not painful or itchy.

PE: T 38.6 P 98 R 18 BP 100/65

Tired, moderately ill-appearing

Mild hyperemia conjunctiva OU; mild photophobia

Pharynx with mild erythema of anterior pillars, no exudate or palatal petechiae

Neck supple, no adenopathy

Chest clear

CV 1/6 SEM at LSB

Abd soft NT, no HSM

Nl genitalia

Skin with 1-4 mm pink blanching macules on arms, legs, and buttocks, distal > proximal. There may be one or two macules on the R palm. A few of the macules do not blanch.

Neurologic exam is non-focal, nl strength, DTR and CN exam.

What is your differential diagnosis?

What is your INITIAL work-up? Give a brief rationale for each test.

Test __________ Reason for this test __________________________________

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Write admission orders:

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