A 18-years old previously healthy male presented with 10 day | Figure 1

A 18-years old previously healthy male presented with 10 day history of sore throat and last 5 days of high fever up to 39,5°C.

The GP saw him before onset of fever and prescribed azythromicin (patient is allergic to penicillin). He took this drug for 5 days but without improvement. Because he developed high fever and malaise, and the sore throat become more intense, he came to outpatient department of my hospital day before I saw him. The colegue of mine examined him, ordered laboratory analyses (WBC 6,78, neutrophils 77%, lymphocytes 10.2%, monocytes 12.7%, PLT 136) and she prescribed him cefixime and discharged him home. He took one tablet of this medicine and on the day when I saw him he developed rash on his body which is not pruritic. Because of this, he didn't took another dose of cefixime, and he came to my office. He is still febrile, he has throat pain and malaise. He denies other symptoms. His PHx and SHx are unremarkable. On exam I noticed macular, fairly wel demarcated rash on the sides and back of his head and neck, torso and his arms. His pharynx is inflammed and there is a small reticular exudate on both tonsills which are not enlarged. The rest of exam is unremarkable.

Laboratory analyses: RBC 4.78; Hgb 153; WBC 5.30 (ne. 3,68; ly. 1.16; mo. 8.5); Tr 97; CRP 23,2; AST 77; LDH 317; CK 1574). Diagnosis of viral infection was made. What is your opinion?

Case Report

1. Patient Description:

   • Age: 18 years old male
   • History: 10 days of sore throat and 5 days of high fever (up to 39.5°C).

2. Initial Treatment:

   • Prescribed azithromycin (allergic to penicillin) for 5 days with no improvement.

3. Current Condition:

   • Developed high fever, malaise, and worsening sore throat.
   • Lab results:
     • WBC: 6.78
     • Neutrophils: 77%
     • Lymphocytes: 10.2%
     • Monocytes: 12.7%
     • PLT: 136.

4. Examination:

   • Fever, throat pain, malaise.
   • Macular rash noted on the head, neck, torso, and arms. Pharyngeal inflammation with small reticular exudate on both tonsils.

5. Laboratory Analyses:

   • RBC: 4.78; Hgb: 153; WBC: 5.30 (ne. 3.68; ly. 1.16; mo. 8.5); Tr: 97; CRP: 23.2; AST: 77; LDH: 317; CK: 1574.

Additional Cases

• Case 1: 18-year-old boy with 7-day history of fever and sore throat, treated with procaine penicillin and metronidazole.
• Case 2: 39-year-old man with fever, dyspnea, and rash. Suspected DRESS syndrome.
• Case 3: 20-year-old male with high fever and skin changes, presumed syphilis.

For more cases, see the images and reports above.