What’s Your Diagnosis? A 1-year-old Boy With Rhinorrhea

Welcome to this month’s What’s Your Diagnosis Challenge!

But before we begin, check out if you got last month’s case right, about a 4-year-old with fever, right leg pain, and difficulty walking. Click here to check out the answer!

Case Presentation: a 1-year-old boy with rhinorrhea, congestion, cough, and fever

You arrive to a busy afternoon shift in the ED. Your first patient is a 1-year-old boy with rhinorrhea, congestion, cough, and 3 days of fever up to 39.4?C (103?F), measured rectally. His parents state that he has been playful at home and continues to eat and drink normally. They have been giving him acetaminophen and ibuprofen sporadically, but today he developed a generalized rash, and they became concerned. His vital signs are as follows: temperature, 38.7?C (101.7?F); heart rate, 135 beats/min; and blood pressure, 85/55 mm Hg. On examination, the rash is macular, erythematous, and blanching, but his eyes and mouth appear normal.

Does he need laboratory workup, or can you safely offer supportive care? Should he be on isolation, either for his own safety or for the safety of others?

Case Conclusion

The 1-year-old boy received antipyretics and was smiling, playful, and eating a cookie. After reviewing the history and physical examination findings, you decided that he did not exhibit any red flags. He had been vaccinated appropriately for his age, had not traveled recently, had a blanching rash that spared the mucous membranes, and he otherwise looked very well. You explained this to his parents and discussed that this was most likely a benign viral exanthem related to his viral upper respiratory infection and that it should self-resolve. You recommended supportive care, as needed, until the rash resolved.

Review the issue to find out what more of the authors’ recommendations.

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Last Updated on July 9, 2020

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