An unvaccinated 20-month-old girl is brought to the emergency department with a rash. Three days ago, she developed a fever along with cough, congestion, and red eyes. The rash appeared on her face yesterday and spread to her trunk, arms, and legs today. The patient's temperature is 39.4 C (103 F). She is lethargic and ill appearing. Physical examination shows conjunctival injection and a diffuse, maculopapular, erythematous rash. She is admitted to the hospital for further management. Deficiency of which of the following is associated with a high rate of complications from this patient's condition?

Question

An unvaccinated 20-month-old girl is brought to the emergency department with a rash.  Three days ago, she developed a fever along with cough, congestion, and red eyes.  The rash appeared on her face yesterday and spread to her trunk, arms, and legs today.  The patient's temperature is 39.4 C (103 F).  She is lethargic and ill appearing.  Physical examination shows conjunctival injection and a diffuse, maculopapular, erythematous rash.  She is admitted to the hospital for further management.  Deficiency of which of the following is associated with a high rate of complications from this patient's condition?

Quizplus · Accepted Answer

11ec160b_3843_03ee_9249_0b83fdb4932b_MD0001_00 This patient's history of fever, cough, congestion, and conjunctivitis followed by a maculopapular rash is consistent with measles. Measles is a highly contagious paramyxovirus that spreads by contact or aerosolized respiratory droplets. This vaccine-preventable infection can be life-threatening. The classic exanthema starts on the face and spreads in a cephalocaudal and centrifugal pattern. Erythematous, blanching, maculopapular lesions often progress to a deep red or brown, nonblanching, coalesced rash. Vitamin A supplementation is recommended, especially in patients with vitamin A deficiency. Acute measles infection depletes vitamin A stores, resulting in a risk of keratitis and corneal ulceration. Vitamin A helps prevent and treat these ocular complications. In addition, it reduces risk of other comorbidities (eg, pneumonia, encephalitis), recovery time, and length of hospital stay. No other vitamin is linked to measles. (Choice B) Vitamin B₆, or pyridoxine, deficiency can result in oral abnormalities (eg, stomatitis, cheilosis) and irritability. Vitamin B₆ is given therapeutically in specific circumstances (eg, to decrease adverse side effects of isoniazid therapy, to decrease homocysteine levels). (Choice C) Deficiency of vitamin B₁₂, or cobalamin, results in macrocytic anemia; hypersegmented neutrophils on peripheral smear; and neurologic signs, such as paresthesias. Patients with a vegan diet are at risk as this vitamin is only found in animal products. (Choices D, E, and F) Like vitamin A, vitamins D, E, and K are fat-soluble vitamins and often present in patients with fat malabsorption (eg, cystic fibrosis). Vitamin D deficiency results in bony abnormalities, such as rickets and osteomalacia. Vitamin E deficiency results in hemolytic anemia and neurologic abnormalities (eg, ataxia). Vitamin K deficiency presents with easy bleeding (eg, easy bruising, gum bleeding, hematuria, hematochezia). Educational objective: Vitamin A can be beneficial in the treatment of measles infection by reducing comorbidities (eg, ocular complications, diarrhea, pneumonia), recovery time, and length of hospital stay. __________ References: Vitamin A for treating measles in children. (http://www.ncbi.nlm.nih.gov/pubmed/16235283) Use of combination measles, mumps, rubella, and varicella vaccine: recommendations of the Advisory Committee on Immunization Practices (ACIP). (http://www.ncbi.nlm.nih.gov/pubmed/20448530) Measles. (http://www.ncbi.nlm.nih.gov/pubmed/21855993)

An Unvaccinated 20-Month-Old Girl Is Brought to the Emergency Department