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Fever with Non-pruritic Truncal Eruption
AZCOM/KRMC/Az Desert Dermatology
Kingman, Arizona
January, 2003
Presenters: Christian B. Anderson DO PharmD RPh, Tom Mackey DO
Program Director: Don A. Anderson DO
Clinical Presentation
4 Year Old Caucasian Male.
History
Chief Complaint: 4 yr old with unresponsive fever, irritability,
adenopathy, orolabial erythema/fissures adenopathy, and distal edema.
Patient is a Caucasian male with 7day history of fever >102.5, malaise,
anorexia, and irritability followed by a nonpruritic truncal eruption on
day 2 then a progressively worsening conjunctival injection (mild),
orolabial and nostril dryness and fissures, cervical adenopathy, and
swollen/painful distal extremities. All of which proved to be
unresponsive to acetaminophen, ibuprofen, amoxicillin, and azithromycin
as variably dose by the patients
primary physician during the 7 days prior to referral to our clinic
Physical Examination
This 4 y.o. WDWN
caucasian boy was alert yet unwilling to communicate (not his norm) and
exhibited general lethargy, malaise, ease of irritability, and refusal
to interact during the examination.
Physical exam as follows: Mild nonexudative conjunctival injection,
severe orolabial/nasal mucosal erythema dryness and bleeding fissures,
pharyngeal erythema with a white tonsillar exudate, brilliantly red
tongue consistent with "strawberry tongue", bilateral cervical
adenopathy ranging from 0.5 to 1.75cm, nonpruritic fine truncal
erythematous maculopapular eruption sparing the distal extremities, and
bilateral symmetric tense painful edema of his wrists, hands, ankles,
and feet limiting his ability to ambulate and grasp objects. The
remainder of the exam was considered within normal limits.
Figure 1 to Figure 5. (click image to zoom)
Laboratory Tests
CMP, CBC with differential, UA all within
normal limits with exception of mild leukocytosis.
Differential Diagnosis
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