Question

Six-year-old Lydia presents with her mother with a chief complaint of “I don’t feel well and I have a rash.” Mom states it started yesterday on her face and is much worse today. Lydia has had a fever for two days and complains of a sore throat. What questions would you include in your history and what characteristics of the physical assessment would help in determining the origin?

What would your differential diagnosis be? Be sure to include how you would determine your diagnosis and how you would treat the condition. Keep in mind there may be several different answers possible depending on what information you obtained during your assessment.

Answer 1

The possible diagnosis is Scarlet fever which is common in children between age group of 5 and 15 years. The symptoms are fever , sore throat and rashes all over the body.

Questions to be included in the history :

1. When did the rashes began ?
2. Where did the rashes appear first ?
3. Has the tounge reddened and swollen when it all started ?
4. What is the temperature and its frequency? Does it subside after medication?

These questions give general idea of the type of fever and helps in diagnosis.

Characterstics of physical examination which helps in its origin :

• If the rash looks as if it is sun burn and when the pressure is applied on the rash, if the rash turns pale it is most indicative of scarlet fever.
• If the folds of the skin appears more red when compared to the rash itself it is also indicative of scarlet fever.
• If the tongue appears more red and swollen along with flused face ,it is possibly scarlet fever.
• There may be swollen lymph glands.
• Nausea, vomiting may also be associated.

Differential diagnosis :

• Scarlet fever
• Strep throat
• Throat infection
• Pharyngitis.

How to identify the diagnosis :

Since there is fever , sore throat and rashes , scarlet fever is the most possible reason as it is seen commonly in children . Throat swab can also be send for the identification of organism causing fever.

Treatment :

• Scarlet fever is treated with analgesics like acetaminophen which also helps in reducing temperature along with its anti inflammatory properties.
• A course of antibiotics is prescribed as the bacteria is responsible for this fever . Usually treated with antibiotic like pencillin . If allergic to pencillin, erythromycin is drug of choice.
• Warm saline water gargling provides comfort which can be done at bed time.

Thank you.