CASE 73
A group of 28 college students traveled to India. Several of the students had not received childhood immunization because of nonmedical exemptions. Six of these students became sick with a febrile rash disease while they were in India. The index patient returned to the United States early despite recommendations not to do so by the local public health authority. During his travel, he had fever, cough, conjunctivitis, and coryza, and within 24 hours of his arrival he developed a rash that began on his forehead and spread to his trunk and extremities.
PHYSICAL EXAMINATION
Physical examination of the index patient (Patent X) is presented here.
LABORATORY STUDIES (PATIENT X)
Diagnostic Work-Up
Table 73-1 lists the likely causes of illness (differential diagnosis). A diagnosis was made on the basis of exanthematous fever and epidemiologic grounds (e.g., lack of immunization and exposure history). Investigational approach for confirmation of clinical diagnosis (if needed) may include
TABLE 73-1 Differential Diagnosis and Rationale for Inclusion (consideration)
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