A 15-month-old girl is brought to the urgent care center due to 4 days of fever. Her father says, "Our entire family was sick with a cold last week, but no one had a fever for this long." The patient's symptoms began with rhinorrhea, cough, sore throat, and fever with daily temperatures 38.9 C (102 F). Three days ago, she developed bilateral conjunctival erythema with watery discharge. Yesterday, an erythematous rash appeared on her cheeks and slowly spread to the rest of her body. She attends day care 5 days a week, and several other children have been ill with similar symptoms, one of whom is currently hospitalized. The patient is otherwise healthy with no significant medical history. Her parents refused immunizations when she was age 12 months, as she had a fever after vaccination at age 6 months. Temperature is 39.4 C (103 F). Physical examination shows an ill-appearing girl lying in her father's arms. A maculopapular rash is present on the face, trunk, and proximal extremities. Bilateral conjunctivae are erythematous without discharge, and there are multiple anterior cervical lymph nodes bilaterally that are 3-5 mm (0.12-0.2 in). The hands, feet, and oropharynx appear normal. Which of the following is the most likely cause of this patient's symptoms?

Question

A 15-month-old girl is brought to the urgent care center due to 4 days of fever.  Her father says, "Our entire family was sick with a cold last week, but no one had a fever for this long."  The patient's symptoms began with rhinorrhea, cough, sore throat, and fever with daily temperatures >38.9 C (102 F).  Three days ago, she developed bilateral conjunctival erythema with watery discharge.  Yesterday, an erythematous rash appeared on her cheeks and slowly spread to the rest of her body.  She attends day care 5 days a week, and several other children have been ill with similar symptoms, one of whom is currently hospitalized.  The patient is otherwise healthy with no significant medical history.  Her parents refused immunizations when she was age 12 months, as she had a fever after vaccination at age 6 months.  Temperature is 39.4 C (103 F).  Physical examination shows an ill-appearing girl lying in her father's arms.  A maculopapular rash is present on the face, trunk, and proximal extremities.  Bilateral conjunctivae are erythematous without discharge, and there are multiple anterior cervical lymph nodes bilaterally that are 3-5 mm (0.12-0.2 in).  The hands, feet, and oropharynx appear normal.  Which of the following is the most likely cause of this patient's symptoms?

Quizplus · Accepted Answer

Explanation: 11ec2b69_bfae_3bb9_8f63_433c103aa690_MD0005_00 Rubeola, also known as measles, is a highly contagious, potentially fatal, vaccine-preventable disease. Measles should be considered in patients with fever and a rash, especially those with a history of recent foreign travel or incomplete immunizations, such as this patient. Prodromal symptoms include fever and fatigue in addition to cough, coryza, and conjunctivitis. After 2-4 days, patients are often ill-appearing with a classic maculopapular rash that starts on the face and spreads cephalocaudally. The rash is initially erythematous and blanching but may later coalesce and appear non-blanching, hemorrhagic, or dark brown. Some patients develop white, pinpoint lesions (known as Koplik spots) on the buccal mucosa. These lesions appear after the onset of prodromal symptoms and often resolve when the rash appears. Treatment is generally supportive (eg, intravenous fluids, antipyretics); however, vitamin A is indicated in severe cases to reduce complications and mortality. maculopapular rash (Choice A) Kawasaki disease is a vasculitis characterized by ≥5 days of fever plus ≥4 clinical criteria (conjunctivitis, mucosal changes, lymphadenopathy >1.5 cm [0.6 in], rash, extremity changes). This patient, with only 4 days of fever and 2 clinical findings (ie, rash, conjunctivitis), does not meet the diagnostic criteria for Kawasaki disease. (Choices B and C) Parvovirus causes erythema infectiosum, which presents with a nonspecific prodrome (eg, fever, cough) followed by a rash (erythematous cheeks, reticular truncal rash) in school-aged children. Roseola also presents with fever, often without additional prodromal symptoms, followed by a rash after the fever subsides. Outbreaks of these viral infections are common; however, illness is typically mild in otherwise healthy children. This partially immunized, ill-appearing child more likely has measles. erythematous cheeks (Choice E) Streptococcus pyogenes causes scarlet fever, which presents with fever, pharyngitis, and a sandpaper-like rash. Cough and conjunctivitis are not associated with scarlet fever. sandpaper-like rash Educational objective: Measles (rubeola) is a vaccine-preventable viral infection that presents with a prodrome of fever, cough, coryza, and conjunctivitis. A maculopapular rash begins 2-4 days after initial symptoms and spreads in a cephalocaudal pattern. Patients are typically ill-appearing. References: Measles. (http://www.ncbi.nlm.nih.gov/pubmed/28673424)

A 15-Month-Old Girl Is Brought to the Urgent Care Center