Approach to bacterial causes of fever and rash (pediatrics) Quiz: Ace Your Exams
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A 7-year-old boy is brought to the office for fever, headache, and rash. The patient returned from a camping trip in Oklahoma two weeks ago. He first developed an intermittent fever with temperatures as high as 40°C (104°F). Three days after the fevers first started, the patient developed a maculopapular erythematous rash on the ankles and wrists that subsequently spread to the trunk, palms, and soles. The patient also reports fatigue and abdominal pain. Past medical, family, and surgical histories are non-contributory. Temperature is 37.9°C (100.2°F), pulse is 120/min, respirations are 20/min, blood pressure is 100/66 mm Hg, and oxygen saturation is 99% on room air. On physical exam, a non-blanching erythematous petechial rash is seen on the chest, trunk and extremities, including the palms and soles. Cardiopulmonary and abdominal exams are unremarkable. Labs are shown below. Which of the following should be ordered to confirm the most likely diagnosis?
| Laboratory value | Result |
| Serum chemistries | |
| Hemoglobin | 13.5 g/dL |
| Hematocrit | 40 % |
| Leukocyte count | 8,100 /mm3 |
| Platelet count | 142,000/mm3 |
| Neutrophils, segmented | 70% |
| Lymphocytes | 20% |
| Alanine aminotransferase | 60 U/L |
| Aspartate transaminase | 80 U/L |
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