Young man with high fever and rare skin changes in shape of maculopapular rash

A 20-years male presented with a history of high fever (up to 40,5°C) for 6 days, rigors, and 3 days of few (<15) skin changes, mostly on the trunk, which is ~0,5 cm diameter, erythematous, ovoid with clear edges and with barely visible desquamation. First 2 days of illness he has loose stools. He had no other complaints. GP prescribed him cefixime, which he took for 3 days but without benefit. The patient has tonsillopharyngitis with a fever 10 days before a current visit, for which he got penicillin injections. After the 1st dose of penicillin, fever and symptoms disappeared, so he stopped therapy after 3rd dose.

On exam, he was febrile (38°C), slightly fatigued, in good condition. Beside described rash and heart murmur for which his know from childhood and tachycardia, rest of examination was unremarkable. Lab. results: Le 7600 (ne. 77.9%); CRP 106.2.

I presumed syphilis because such previous quick response to penicillin and because of rash, so I prescribed penicillin again.

Four days later, he reported that fever abated after 1st dose of penicillin and that he is feeling well. The rash started to fade and now appeared only as salmon colored macules.

After 10 days of therapy, he is doing well and skin changes disappeared. Heart murmur persisted. TPHA & VDRL came back negative. I suggested the cardiac US because of that murmur.

What was the disease of this patient?

More about this case

Rare

Some Brief Cases

A 70-years old male patient with 11 years history of RA, presented to my office with 20 days history of both lips erosion which are not healing. He used gentamicin cream and ciprofloxacin tablets based on result from erosion swab, but without improvement. My provisional diagnosis is herpes infection which could not heal itself because of immunosuppresion, so I prescribed acyclovir 400 mg, tid, and ordered serology for HSV1 and HSV2, and suggested follow up for a few days.

A 18-years old previously healthy male presented with 10 day history of sore throat and last 5 days of high fever. The GP saw him before onset of fever and prescribed azythromicin. Diagnosis of viral infection was made.

A 78-year male patient with personal history of asthma, hypertension and type 2 diabetes mellitus presented with 3 days history of fever up to 38°C, weakness, fatigue. My working diagnosis is some kind of vasculitis.

16 month old patient who presented to the department with a transient fever and raised rash for the last 24 hours. What is your diagnosis/cause for rash and possible treatments? ** patient had the rash appear before administration of medication to rule out possible allergic reaction to such things**.