Toddler with 2 days history of 103.5 *F. similar age brother | Figure 1

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Toddler with 2 days history of 103.5 *F. similar age brothers not exhibiting symptoms and fever broke before the rash. I am thinking roseola? Diff Dx?

Clinical Cases

  1. 21 month old presents with 4 days of fever, irritability and increased lethargy with initial onset being unilateral sinus infection with frank green mucusol discharge.

    • Sinus component appears to be resolved. Lethargy noted to be transitory post spontaneous agitation and limited to patient appearing sleepy but easily roused.
    • Pt presented to EMS secondary to mother's concern for rash and lethargy. Rash developed late on day 3.
    • Mother states patient would spontaneously agitate with pt holding head and appearing to be light sensitive for approx 3-5 minutes of inconsolable crying.
    • Pt is febrile up to 40 C but well controlled at home with Tylenol and Motrin. Rash is diffuse across torso and follows hairline on head. Rash appears macular.
    • Pt also presents with periorbital edema w/o discharge.
    • No apparent respiratory or cardiac component.
    • Initial allergen tests show negative allergies. No recent change in laundry detergent or clothing materials.
    • Differential?

  2. A previously healthy 4-year old presented with 7 days of fever up to 38°C, cough and ear pain.

    • On exam, the right external ear canal is swollen with purulent secretion, and tympanic membrane is invisible due to swelling.
    • There is erythema behind the auricle, and papulo-pustular granular rash on auricle and in front of it. (What would be differential diagnosis? What kind of rash is this?)

  3. 8 year old with fever and ear redness.

    • Upon further inspection, this red ring goes to scalp and completes target rash. Treated for erythema migrans.

  4. A 31-year-old woman, with no prior medical history of note, presented to the medical ED with a generalized body skin rash that had persisted for several hours.

    • She had been in good health until 6 days before admission when she started to have fever accompanied by chills, generalized body aches, malaise, and occasional dry cough.
    • Three days later, she visited her primary care physician, who prescribed co-amoxiclav and paracetamol.
    • One day later, she developed a generalized erythematous skin rash.
    • Initially, she noticed the rash on her face and later discovered involvement in other regions upon waking up in the morning.
    • The rash did not cause itching but was accompanied by a mild burning sensation on her back.
    • The patient denied any chest pain or breathlessness. However, she did report having a poor appetite, epigastric pain and a few times vomiting.
    • There were no other relevant symptoms upon further systemic inquiry.
    • On examination: Widespread maculopapular rash, most evident on the trunk and upper arms and scattered on the face and extremities.
    • There was a palpable node at the right posterior cervical. No lesion on oral cavity and throat exam except for mild erythema of the oropharynx.
    • Your thoughts in the case? What is the most likely diagnosis?

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  1. A 52-year-old man presented with a 20-minute history of chest pain radiating to the left shoulder and neck, associated with dyspnea and diaphoresis.

    • He had a history of hypertension, long-term smoking, and a sedentary lifestyle.
    • On physical examination, bibasilar crackles were noted on lung auscultation.
    • An electrocardiogram (ECG) was performed in the primary care setting, and the patient was promptly referred to the emergency department.

  2. A 28-year-old woman presented with a 3-day history of intense pruritus over the lower back.

    • She reported no recent travel or exposure to new environments. She cares for a small kennel with approximately eight dogs rescued from the streets.
    • Physical examination revealed multiple small vesicles, some clustered and others scattered, predominantly involving the lumbar region and the left gluteal area.

  3. A 4-month-old male infant presented with skin lesions localized to the chin for the past 3 days.

    • Physical examination revealed multiple small pustules with surrounding inflammatory signs on the chin, along with a few scattered papules on the chest.

  4. Patient in late teens presenting after a collapse, no chest pain, no previous cardiac history, no history of sudden death in family.

    • Are there any features in this EKG that would warrant further work-up or is this just a pediatric EKG?