### 26 years old man with history of fever 7 days ago presented with such skin lesions since 3 days. Associated with dry cough, coryza and respiratory distress. The rash first appeared on face and then spread down the body. SpO2 is 95% and vitals are stable. What is the diagnosis and treatment ???



A diagnostic dilemma But most likely diagnosis in order of possibilities are 1.Viral exanthematous fever. - - measles -- Roseola infection -' Rubella 2.Scarlet fever 3 .Erythema infectiosum also called fifth disease 4 .Rickettsial disease - particularly rocky mountain spotted fever 5 .lyme disease 6.Erythema multiforme 7.Toxic shock syndrome- due to staphylococal aureus 8.Drug induced anaphylaxis or Stevens Johnson's syndrome 9- Henoch Schonlein purpura . 10 - Meningococcemia Investigations required are - CBC , ESR , CRP .weil Felix test for rickettsial disease. What ever is the diagnosis- patient has presented with ARDS . Get ABG studies done. Give symptomatic treatment. Oxygen support with mask Adequate fluid support neither overload nor dehydration Steroids are optional if required Antibiotics An X- chest to rule out ARDS , pneumonia

Fever, pin point down ward spreading rashes (first appear on back of ear then face) , any of cough /coryza /conjunctivitis are typical of of MEASLES. See for Koplik spot though always may not be found. Take history of recent travel to endemic area, contacts etc. Samples for confirmation are..... In first 5 days... Throat swab for virus isolation 4-28 days...... Blood for antibody detection 5-6 days..... Both throat swab and blood R/O dengue (though less possibility) Treat with Vitamin A 2 Lac IU Stat and after 24 hrs. PCM, Fluid, symptoms management. Report the case in CIF form (Case information form) to Surveillance medical officer of WHO. Or contact atleast with district program officers. If total no. of similar cases in the community is 5 or more in a month then contact survey in community is needed.

Viral exanthem? Rx. 1. Topical calamine lotion application twice a day. 2. Levocetrizine 5mg twice a day for itching if present

D/D 1 viral exanthematous fever 2erythema infection 3 drug induced anaphylacti4 4Henoch scholein purpura. Needs further investigations and evaluation. TT. Symptomatic treatment Mechanical ventilation. Adequate calories intake and fluid intake Maintain I/O and calories chart. Constant monitoring and good nursing care.

Probably it looks like a Viral process to me but you have to see for rare causes like Rickettsial and Drug induced reaction.... Viral prodrome is also present which shows that it is probably a vural exenthem




Viral exanthem- dengue

Viral infection

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