%27%3e%3cg%20id=%27Group-14%27%20transform=%27translate(13.000000,%20103.176124)%27%3e%3cg%20id=%27Group-Copy-5%27%20transform=%27translate(0.000000,%20182.676124)%27%3e%3crect%20id=%27Rectangle-8%27%20fill=%27%23E2E0DE%27%20x=%270%27%20y=%270%27%20width=%2736%27%20height=%2736%27%20rx=%2718%27%3e%3c/rect%3e%3cpath%20d=%27M28,27.6503435%20C28,22.127496%2023.5228474,17.6503435%2018,17.6503435%20C12.4771525,17.6503435%208,22.127496%208,27.6503435%20M18,16.3472505%20C20.8165136,16.3472505%2023.099749,14.0640151%2023.099749,11.2475015%20C23.099749,8.43098783%2020.8165136,6.1477524%2018,6.1477524%20C15.1834863,6.1477524%2012.9002509,8.43098783%2012.9002509,11.2475015%20C12.9002509,14.0640151%2015.1834863,16.3472505%2018,16.3472505%20Z%27%20id=%27Combined-Shape%27%20fill=%27%23FFFFFF%27%20fill-rule=%27nonzero%27%3e%3c/path%3e%3c/g%3e%3c/g%3e%3c/g%3e%3c/g%3e%3c/svg%3e)

### Deleted account

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?**

---

### Trending now

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?