CASE 74
A 3-year-old boy was brought to a clinic for complaints of low-grade fever, swollen lymph nodes, and a rash for 3 days.
PHYSICAL EXAMINATION
LABORATORY STUDIES
Diagnostic Work-Up
Table 74-1 lists the likely causes of illness (differential diagnosis). A diagnosis can be made on clinical and epidemiologic grounds, although laboratory confirmation is preferred. Laboratory investigational approach to delineating the etiology of such infection may include
TABLE 74-1 Differential Diagnosis and Rationale for Inclusion (consideration)
Rationale: Childhood viral infections can be difficult to distinguish from one another. If the patient is quite ill, a bacterial etiology may be suspected, although with RMSF and typhoid fever, there is often a relevant exposure history. Rubella is rare in vaccinated children, but it certainly may be considered in those not immunized. It is similar to measles, but with rubella, patients are less sick, and Koplik spots are not present. The other viral infections (HHV-6 and parvovirus B-19) are also common and may be seen in fully immunized children because there are no specific vaccines against these viruses. back.
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