Fever and Rash in child

Age: ‍ ‍monthsyears old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍day history of fever and rash

Peak temperature recorded: ‍° ‍not measured

Pattern of fever: ‍persistentintermittent

Rash located on ‍faceneckarmshandslegsfeetchestabdomenback ‍generalized

Rash described as ‍itchynon-itchy, ‍painfulpainless, ‍blistering, ‍scaling

Alleviating factors: ‍none, ‍effectiveineffective



Associated symptoms: *Try using right-click for negatives*

‍cough, ‍non-productiveproductive of ‍clearcolored phlegm

‍runny nose, ‍clearcolored

‍sore throat

‍shortness of breath

‍chest pain, ‍retrosternal, ‍aching, ‍on exertionat restwith deep breath, ‍mild

‍headache, ‍diffuse, ‍persistentintermittent, ‍pressurethrobbing, ‍mild

‍body ache

‍joint pain

‍night sweats

‍fatigue

‍lethargy

‍irritability

‍rash

‍decrease in fluid intake

‍decrease in urine ouput

‍decrease in appetite

‍nausea

‍vomiting, ‍ episodes ‍per day, ‍, ‍hematemesis

‍diarrhea, ‍ episodes ‍per day, ‍

‍abdominal pain, ‍diffuse, ‍dull, ‍mild

‍dysuria

‍frequency

‍foul-smelling urine

‍flank pain



Contributing factors:

‍daycare

‍similar symptoms in close contacts

‍recent travel

‍recent upper respiratory infection

no history of: ‍asthma, ‍premature birth

no use of: ‍recent antibiotics



Vaccination status: ‍up-to-dateincompleteunvaccinated





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Head: fontanelles ‍soft, ‍normocephalic

Eyes: conjunctiva/sclera ‍normalinjection, lids/lashes ‍normalerythema, ‍PERRL, extraocular movements ‍intact, red reflex ‍present, corneal light reflex ‍symmetrical, fix and follow test ‍intact

Ears: tympanic membranes ‍normal ‍, auditory canal ‍ on ‍rightleft, hearing ‍intact

Nose: ‍clear, ‍nasal flaring, discharge ‍clear, ‍

Throat: ‍normal, ‍palate intact, ‍redness

Mouth: mucosa ‍normal, dentition ‍normal

Neck: ‍normal, ‍lymphadenopathy, ‍nuchal rigidity, ‍torticollis, ‍, c-spine ‍

Heart: ‍RRR, ‍MRG, ‍normal S1 and S2

Lungs: ‍clear bilaterally, ‍abnormal sounds, ‍retractions

Chest: ‍tenderness on ‍rightleft ‍

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍guarding, bowel sounds ‍normal, ‍, ‍CVA tenderness ‍

Genitourinary: external genitalia ‍normal, testes ‍descended, penis ‍normal, Tanner stage ‍

Extremities: ‍normal inspection, ‍joints ‍normal, ‍limited ROM, ‍normal spine, Barlow ‍negative, Ortolani ‍negative, ‍normal pulses, cap refill ‍< 3> 3 sec

Skin: ‍rashlesions on ‍

Musculoskeletal: joints ‍ ‍normal, ‍limited ROM

Neurologic: cranial nerves ‍grossly intact, overall motricity ‍normal for agelimb weakness, muscle tone ‍normal for age, gait ‍appropriate for age, reflexes ‍intact 2+

Mental status: ‍alert, ‍, reactive to ‍





ASSESSMENT:

‍Viral exanthem ‍likelysuspectedpossible

DDx: viral exanthems, viral urticaria, erythema infectiosum, roseola, parvovirus B19 infection, hand, foot, and mouth disease, measles, rubella, bacterial infections, scarlet fever, meningococcemia, drug reactions Stevens-Johnson syndrome, toxic epidermal necrolysis, systemic lupus erythematosus, juvenile idiopathic arthritis, Lyme disease, Rocky Mountain spotted fever, Kawasaki disease, Henoch-Schönlein purpura, infectious mononucleosis, HIV acute seroconversion, syphilis, varicella, zoster, coccidioidomycosis, vasculitis, leukemia, heat rash, vaccine reaction





PLAN:

Investigations:

- Chest X-ray

- Covid test

- Throat swab

- Urine culture

- Blood work: ‍CBC, ‍CRP, ‍blood culture

Treatments:

- ‍Acetaminophen (Pediatric)

- ‍Ibuprofen (Pediatric)

- Encourage hydration

- Antibiotics if bacterial infection

Further care:

- Follow-up in ‍ ‍hoursdays

- Return if fever persists for more than 3 days, if new symptoms develop, or if condition worsens

- Referral to pediatrician if no improvement after 72 hours

- Referral to ER if seizures, severe headache, stiff neck, or other signs of serious illness occur