27yr F has come yesterday with c/o body pain headache and throat irrtation and fever with shivering and mild cough she had 2or3 vomiting before that . o/e she is febrile temp 101 f pulse 100/bpm bp 100/70 no dehydration .in my area as earlier i have notified it is endamic with swine flue ie h1n1. so she was given paracetamol650mg tds and Azithromycin 500mg od . today morning she has not taken any medication but noted rashes as in picture predominently on face no burning no itching etc o/e rashes are discreet and all over mainly face on hard palate and soft palate also suspicious for kopliks spot. so confusion is .are these rashes of d/d 1 swine flu 2 G measales 3 dengue fever or 4 drug induced . can you help me in dx

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Dengue rash mainly first appears first in trunk not in face, appears in face later & from 4th day there will be afebrile stage. Pt do not have runny nose or SOB which is S/O Swine flu. Rashes not likely to Measles, adult measles very rare & fatal.Do not satisfy German Measles also. DD 1 Viral Pharyngitis 2 Drug induced allergy. Investigation: Throat swab for C/S,Urine for REcC/S.CBC pending Treatment:WS gargle, Steam inhalation, Plenty of fluid to drink,Tab Montelucast Fexofenadine BD×7 days,Atarax skin lotion to apply locally,PCM SOS,Inj Promethazine IM sos,Let report come & treat accordingly Sir.

Thanks Dr Kedar Chandak
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Nonspecific Viral fever rash . Platelet. Count and APTT exclude Dengue . H1N1. Usually start with respiratory symptoms and signs. CxR, PNS as baseline investigations shall be done. Treat with general measures for fever. Measles unlikely in this case and follow up for 7 days.

1.Measles rash doesn't look like these so ruled out, 2.for swine flu there is no h/o sob and we have to get confirmation by taking throat swab with precautions . 3.could be dengue and confirm it by Elisa .4.could be drug induced , antibiotics in viral fever may lead to that. 5.other D.D includes here are malaria,Urinary tract infections,acute pharyngitis

This I is not measly rash URTICARIA may be from Azithromycin or PARACITAMOL. Koplic, spot & rash seen on 4th day of fever TLC DLC DEGIUE ELISA SWINE FLU ELISA RX ORAL FLUIDS FRUIT JUICE COLD SPONGING HOT SALINE GURGLE PARACITAMOL IF NOT ALLERGIC TO IT

Rash on 2nd day of fever, is unlikely to be measles . Koplik spots come earlier than exantheme. CBC, PLT count, ,dengue profile will rule out dengue. Typical rash of Dengue is Purpuric rash . This is likely to be drug rash or some flu exantheme Stop Azithromycin, add antihistamines .

Looks like disease rash ns1 swab culture h1 n1 2 decho kopplick spot CBC then decide by that time atarax & levocet bd

Go with investigation cbc, MP, widal, dengue, these rashes are urticaria type

Looks like uricaria... Fever profile, dengue, chicken gunia.. Lft Planty f water.. Multivitals support with IV.

Looks like urticaria

Drug induced rashes

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