SOLVED364

A 5-year-old boy is evaluated for fever and rash. He first felt unwell 5-days ago. His initial symptoms included fevers, malaise, dry cough, rhinorrhea, vomiting, and watery, non-bloody diarrhea. He had no chest pain or shortness of breath. Three days ago, he developed white spots inside his cheeks. Yesterday, he developed a rash on the face that has now spread to the neck, trunk, and extremities. He has no pertinent medical or family history and currently takes no medications. He is originally from Pakistan and moved to the United States 3-years ago. His immunization history is unknown. On physical examination, the vital signs include temperature 99.9 °F, heart rate 102/min, blood pressure 112/82 mm Hg, and peripheral oxygen saturation 99% on room air. The bilateral conjunctiva is erythematous. There are scattered whitish spots on the bilateral buccal mucosa. Skin evaluation is notable for a diffuse erythematous, maculopapular rash throughout the head and neck, trunk, and extremities. There is palpable cervical, axillary, and inguinal lymphadenopathy. Lung auscultation is unremarkable. Serum laboratory tests are as follows: Leukocyte count 7.4 x 109/L Hemoglobin 13.3 g/dL Platelet count 201 x 109/L Sodium 132 mEq/L Creatinine 1.2 mg/dL Aspartate aminotransferase 25 U/L Bilirubin, total 0.3
SCIENCE
HEALTH SCIENCE
NURSING

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