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Problem Solving – Case 3
A 10 months old infant presents with a day history of blanching confluent rash which started on his face and now covers his entire body. He is miserable with conjunctivitis and fever of 38 C. the illness started with runny nose and cough 5 days previously.
A 10 months old infant presents with a day history of blanching confluent rash which started on his face and now covers his entire body. He is miserable with conjunctivitis and fever of 38 C. the illness started with runny nose and cough 5 days previously.
What is the most likely diagnosis?
A. Scarlet fever
B. Sweat rash
C. Chicken pox
D. Measles
Explaination of the case
Choice A:
a) Points against: Fever is followed in 2 days by rash + less aggressive prodroma (miserable with) + sore throat [it is a streptococcal infection ]
Choice B:
a) Points against: the disease is obviously of infectious etiology
Choice C:
a) Points against: presents with fever of low grade followed 1 day later by rash
Choice D: [the right answer]
a) Age + aggressive prodroma + 4 to 5 days between fever and rash appearance (showing runny nose and cough) + conjunctivitis + 38.5 C.
b) The rash covers the entire body eventually.
N.B. German measles is excluded as the rash in it never appears in the whole body at the same time ,i.e. when the rash reaches certain parts it disappears in other.
N.B. measles must show :Coryza (runny nose)+ Cough+ Conjunctivitis
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