Young Boy With Fever, Rash,
and Oral "White Spots"
A4-year-old boy has a 4-day history
of fever; a persistent dry,
irritating cough; coryza; and a
nonpruritic rash. The rash started
around the ears and then spread over
the trunk and limbs.
The child was delivered
without incident at full term and has
developed normally. There is no history
of allergy, and the child takes no
medications. Because of the parents'
religious beliefs, the child has had no
The patient appears
ill and feels miserable. Temperature,
38.4C (101.2F); heart rate,
120 beats per minute; respiration rate,
26 breaths per minute. Conjunctival injection with nasal "snuffles," pharyngitis,
and "white spots" on the buccal mucosa are noted. A confluent, erythematous
maculopapular rash covers the entire body. Lymph nodes are not palpable.
No swelling of the extremities is noted. Results of cardiac, respiratory, and abdominal
examinations are normal.
What is your clinical impression--and the likely cause of these findings?
- Kawasaki disease
- Scarlet fever
- Toxic shock syndrome
- German measles
- Drug-induced rash
1. Krugman S, Ward R. Infectious Diseases of Children. St Louis: CV Mosby Co;
FOR MORE INFORMATION:
- Gellin BG, Katz SL. Measles. J Infect Dis. 1994;170(suppl 1):S3-S14.
- Isaacs D, Menser M. Measles, mumps, rubella and varicella. Lancet. 1990: