Approach to viral exanthems (pediatrics) Quiz: Ace Your Exams

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A 7-month-old girl presents to the pediatrician with one week of malaise. Her parents report that her symptoms started with a decreased appetite and progressed to a fever, cough, red eyes, and a runny nose. Over the last few days, the fever intensified, and yesterday, a rash developed. The patient’s family returned from India two weeks ago. Her routine immunizations are up-to-date. Temperature is 38.6°C (101.5°F), pulse is 155/min, respirations are 36/min, blood pressure is 86/52 mmHg, and oxygen saturation is 97% on room air. On physical examination, the patient is alert and appears uncomfortable. The anterior fontanelle is open and flat. There is mild conjunctival injection bilaterally, coryza, and small white spots with an erythematous base on the buccal mucosa. Cardiopulmonary examination is normal. There is a diffuse erythematous maculopapular rash, as seen in the image below. Which of the following would confirm the most likely diagnosis?

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Measles reverse transcription polymerase chain reaction (RT-PCR)

Rubella IgM

Epstein Barr virus IgM

Enterovirus reverse transcription polymerase chain reaction (RT-PCR)

Human herpsevirus-6 (HHV-6) reverse transcription polymerase chain reaction (RT-PCR)