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Persistent Rash and Fever in a 7-Month-Old Boy


A diagnosis of adenovirus had been made at an urgent care center and zinc-oxide diaper cream was recommended. The rash did not respond and the child grew more irritable. There's more to the case, here.

Figure 1.

Figure 2.

Figure 3.

The parents of a fully vaccinated 7-month-old boy bring the child to the pediatrician’s office because he has had a fever and a rash for the past 4 days. They had been to an urgent care center the day before and were told that the fever and conjunctivitis that was noted were probably from a virus called adenovirus. Zinc oxide diaper cream was recommended for the diaper rash. Today the parents say he is more irritable and the rash looks worse despite frequent diaper changes and regular use of the zinc oxide diaper cream. The child also has a slight runny nose, but no vomiting, diarrhea, cough, trouble breathing, or other symptoms. He has been around other children his age, but as far as the parents know, none of them were ill.

During physical examination the child is calm in his mother’s lap. Vital signs are normal except for a temperature of 38.2°C (101.2°F). His eyes appear injected without discharge and his oropharynx is clear. The neck is supple and demonstrates no significant lymphadenopathy. Lungs and heart sound normal and the abdomen is nontender. The rest of the physical examination is essentially normal except for the findings shown in Figures 1, 2, and 3 at right (click images to enlarge).

What is the most likely diagnosis?
What should you do next?


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