Red Book Online Presents: Diagnosis Detective | October 2024
Editor: Kristina A. Bryant, MD, FAAP
Case contributed by Robert Chong, MD, FAAP, AdventHealth, Orlando, FL
A 7-year-old boy presents with 4 days of fever up to 103°F, malaise, neck pain, and generalized headache. His parents thought he had the flu until they noticed a rash on his wrists and ankles that is now spreading to his trunk (Figure 1). The patient recently returned from a summer camping trip in Georgia. He does not recall being bitten by a tick. On physical examination, he appears somnolent, and the rash is comprised of erythematous blanching macules interspersed with pinpoint, erythematous, non-blanching macules. The child’s temperature is 102°F, heart rate is 120 beats per minute, blood pressure is 90/60 mm Hg, and respiratory rate is 36 breaths per minute. The WBC is 10 X 1000/microliter, the platelet count is 120 X 1000/microliter, and the blood sodium level is 129 mEq/milliliter. The patient is fully vaccinated. There are no sick contacts in the family who reside in a suburban neighborhood in central Florida.
Figure 1.
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