Pediatric Problem Solving-Case15

Pediatric Problem Solving – Case 15
A 15 months old infant presents to the emergency department with a 4-day history of high fever without any localizing sign. She suffers self limiting convulsion and is admitted for observation. The next day the fever subsides, but a red popular rash develops over her trunk and abdomen.
What is the most likely diagnosis:

A. Measles

B. Rubella

C. Roseola

D. Chicken pox

Explanation of the case:

Short self limiting convulsions = due to fever.
The girl had an incubation period of 4 days showing high fever, but without any localizing sign (without 3C of measles: Coryza, cough and conjunctivitis).then she shows red maculo-papular rash starting on her trunk. When the rash appeared, the fever subsided.
 Choice (A): points against ,In measles, there should be localizing sign (3C), and the fever rash relation-ship is different, the fever should rise markedly with appearance of rash on the 4th/5th day of the prodroma, rash starts on the face
 Choice (B): points against: Fever should increase with appearance of rash.
 Choice ( C ): the right answer , Where prodroma is 4 days showing high fever, rash appears after 4 days, first on trunk, fever subsides
 Choice (D): Rash isn’t maculo-papular