CH, 22/M, RH, med student from QC.
Fever with Chills
Pt was apparently well until...
2 days PTC: Pt experienced low grade fever (38C), with associated malaise and chills. Paracetamol was taken with apparent relief of symptoms. (-) HA, nuchal rigidity. (+) rhinorrhea noted.
1 day PTC: Pt's fever increased to 39.6C, still with chills and malaise. Pt then noted multiple, nonpruritic, erythematous, maculopapular lesions all over face, torso and UE, with apparent cephalocaudal spread. Pt sought consult at private MD, was prescribed Ciprofloxacin 500mg BID x 7 days, and sent home.
day of consult: Pt had 2 episodes of nonbilous, nonbloody vomiting. There was intolerance of oral intake, and (+) anorexia, prompting consult.
(+) sore throat
(-) chest pain
(-) dysuria, hematuria, nocturia
(+) dengue - 1990, 1991
(+) MMR vaccination (unrecalled)
(+) PTB - paternal grandfather
(+) DM - father, paternal grandmother
(+) BA - mother, siblings
(+) liver failure - father
Pt is coherent, ambulatory, NICRD.
(+) multiple nonpruritic, erythematous, maculopapular lesions all over face, torso, both UE & LE, "islands of white in a sea of red"
(+) conjunctival injection, pink conjunctivae, (-) nasoaural discharge, (+) TPC, (-) ANM, (+) CLAD (multiple), (-) NVE
AP, (-) heaves, thrills, PMI 5th ICS LMCL, DHS, slightly tachycardic, constant S2 split, (-) m2
ECE, CBS, (-) r/w
Flat abdomen, NABS, (-) organomegaly, (-) m/t
any PWI's? Differentials?
this is an infectious disease case, so it really is a bitch.