Dermatology
This was previously featured in an exam
This was previously featured in an exam
Question 22 of 24
A 20 month old girl is brought into ED with a widespread rash. She has been unwell with a high fever and mild coryzal symptoms for the past 3 days, but her fever resolved last night. The rash has appeared this morning over her trunk and limbs. On examination, she appears clinically well, with an otherwise normal examination. What is the most likely diagnosis?
Answer:
Roseola vs measles:- The roseola rash is usually more pink-red, while the measles rash is more red-brown.
- The rash from roseola begins on the torso and spreads out, while the measles rash starts on the face and moves downwards.
- Children with roseola usually appear well, while those with measles typically look and behave as if they are unwell.
- In roseola the rash appears shortly after the fever ends. In measles, however, the fever symptoms do not subside and instead accompany the rash.
Childhood Exanthems
Dermatology
Last Updated: 5th May 2022
Summary of Clinical Features
| Name | Infectious agent | Clinical features |
|---|---|---|
| Measles | Measles virus |
|
| Scarlet fever | Streptococcus pyogenes |
|
| Rubella | Rubella virus |
|
| Erythema infectiosum (fifth disease) | Parvovirus B19 |
|
| Roseola infantum (sixth disease) | Human herpesvirus (HHV)-6 and HHV-7 |
|
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- Biochemistry
- Blood Gases
- Haematology
| Biochemistry | Normal Value |
|---|---|
| Sodium | 135 – 145 mmol/l |
| Potassium | 3.0 – 4.5 mmol/l |
| Urea | 2.5 – 7.5 mmol/l |
| Glucose | 3.5 – 5.0 mmol/l |
| Creatinine | 35 – 135 μmol/l |
| Alanine Aminotransferase (ALT) | 5 – 35 U/l |
| Gamma-glutamyl Transferase (GGT) | < 65 U/l |
| Alkaline Phosphatase (ALP) | 30 – 135 U/l |
| Aspartate Aminotransferase (AST) | < 40 U/l |
| Total Protein | 60 – 80 g/l |
| Albumin | 35 – 50 g/l |
| Globulin | 2.4 – 3.5 g/dl |
| Amylase | < 70 U/l |
| Total Bilirubin | 3 – 17 μmol/l |
| Calcium | 2.1 – 2.5 mmol/l |
| Chloride | 95 – 105 mmol/l |
| Phosphate | 0.8 – 1.4 mmol/l |
| Haematology | Normal Value |
|---|---|
| Haemoglobin | 11.5 – 16.6 g/dl |
| White Blood Cells | 4.0 – 11.0 x 109/l |
| Platelets | 150 – 450 x 109/l |
| MCV | 80 – 96 fl |
| MCHC | 32 – 36 g/dl |
| Neutrophils | 2.0 – 7.5 x 109/l |
| Lymphocytes | 1.5 – 4.0 x 109/l |
| Monocytes | 0.3 – 1.0 x 109/l |
| Eosinophils | 0.1 – 0.5 x 109/l |
| Basophils | < 0.2 x 109/l |
| Reticulocytes | < 2% |
| Haematocrit | 0.35 – 0.49 |
| Red Cell Distribution Width | 11 – 15% |
| Blood Gases | Normal Value |
|---|---|
| pH | 7.35 – 7.45 |
| pO2 | 11 – 14 kPa |
| pCO2 | 4.5 – 6.0 kPa |
| Base Excess | -2 – +2 mmol/l |
| Bicarbonate | 24 – 30 mmol/l |
| Lactate | < 2 mmol/l |
