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Diagnosis Detective - October 2023

October 1, 2023

Red Book Online Presents: Diagnosis Detective | October 2023

Contributed by Alex Green, MD, Yale New Haven Children's Hospital

The patient is a 3-year-old fully vaccinated male with a past medical history of Alport Syndrome status post renal transplant and is currently receiving 600 mg/m2/dose of mycophenolate mofetil twice daily. The patient presents with 72 hours of fever (Tmax: 104°F), cough, diarrhea, sore throat, conjunctivitis (Figure 1), and a rash that began on the head and spread to the torso (Figure 2). On exam, the patient has bilateral conjunctivitis, intense erythema of the posterior oropharynx (Figure 3) and a maculopapular rash.

The white blood cell count is 3.2 x1000/microliter and the platelet count is 112 x1000/microliter. A chest x-ray is benign. Streptococcus pyogenes PCR from throat swab is negative. Varicella PCR is negative. Blood culture reveals no growth after 48 hours of incubation. Measles IgM is negative. The patient has two sick contacts with similar symptoms, no history of travel, no notable animal exposures, and lives in a suburban setting in Kentucky, U.S.A. 

Child's face with close up of eye that is being examined. Child's face and torso which display red blotches. Open mouth showing areas of inflammation in the back of throat.
Figure 1
Courtesy of Larry Frenkel, MD
Figure 2
Courtesy of Paul Wehrle, MD
Figure 3
Copyright AAP

© 2023 American Academy of Pediatrics. All rights reserved.

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