It is early fall and a 2-year-old boy is brought to the ED by his mother for 2 days of cough, fever as high as 102.2°F, one episode of vomiting, and a rash noted primarily on his left buttock and in and around his mouth. He has no significant medical history, has not been vaccinated recently and is up to date on age- appropriate vaccines.
The mother has not observed any shortness of breath, abdominal pain, or other signs or symptoms.
Vital signs are normal except for a low grade fever of 100.6°F. The physical exam is normal except for the rash. Shown above in Figure 1 is a patch on the left hip/butt area (please click to enlarge). The lungs are clear and the abdomen is benign.
Initial Differential Diagnosis
- Viral syndrome
- Chest x-ray shows peribronchial cuffing
1. What does the case image show?
2. What should you do next?