Pediatric Problem solving - Case 25

Pediatric Problem Solving – Case 25

An 8 years old girl present with low grade fever and a diffuse maculopapular rash. On examination her physician notes mild tenderness and marked swelling of her posterior cervical and occipital lymph nodes. Three days after the onset of illness , the rash has vanished.
What is the most likely diagnosis ?
A.Measles.
B.German measles.
C.Roseola infantum.
D.Infectious mononucleosis.

Explanation of the case:

An 8 years old girl with low grade fever (this is infection).  With Swelling of specific lymph nodes ( posterior cervical & occipital ) and not generalized lymaphadenopathy  And rash whish disappeared 3 days after the onset of illness (very typical of German measles) . This case fulfills the criteria of German measles

Choice A : a. Points against: there is no Koplik spots. b. There is no high fever; there is no conjunctivitis, no coryza and no cough.

Choice B : ( the right choice)

Choice C : a. Points against: the age group of Roseola infantum is from 6 months to 2 years, and the girl’s age is 8 years. b. Fever accompanying Roseola infantum is high fever not low grade fever.

Choice D: a. Points against; there is no evidence of sore throat or presence of any exudates on the tonsils. b. There is no evidence of splenomegaly which is characteristic in case of infectious mononucleosis.