Approach to bacterial causes of fever and rash (pediatrics) Quiz: Ace Your Exams
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A 9-month-old girl presents to the emergency department for evaluation of fever, rash, and irritability. The rash started as generalized redness and progressively worsened. For the past few days, she has been refusing to eat and has decreased urinary output. There is no history of travel or exposure to sick contacts. Birth, family, and surgical histories are non-contributory. Temperature is 38°C (100.4°F), pulse is 180/min, respirations are 32/min, blood pressure is 70/36 mm Hg, and oxygen saturation is 96% on room air. On physical examination, there are bullae on the body and findings on both hands as pictured below. The skin over the bullae peels off easily with gentle pressure. Cardiopulmonary exam is unremarkable except for tachycardia. Abdominal exam is normal. Labs are shown below. Which of the following is the best next step in management?
Reproduced from Wikipedia . Licensed under CC BY 4.0
Reproduced from Wikipedia . Licensed under CC BY 4.0
| Laboratory value | Result |
| Serum chemistries | |
| Hemoglobin | 14 g/dL |
| Hematocrit | 41 % |
| Leukocyte count | 17,100 /mm3 |
| Platelet count | 460,000/mm3 |
| Neutrophils, segmented | 70% |
| Lymphocytes | 24% |
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