Presenter: Christian B. Anderson DO PharmD RPh, Tom Mackey DO

Dermatology Program: AZCOM/KRMC/Az Desert Dermatology

Program Director: Don A. Anderson DO

Submitted on: January 29, 2003

CHIEF COMPLAINT:  Unresponsive fever, irritability, adenopathy, orolabial erythema/fissures adenopathy, and distal edema

CLINICAL HISTORY: Patient is a Caucasian male with 7day history of fever >102.5, malaise, anorexia, and irritability followed by a nonpruritic truncal eruption on day 2 then a progressively worsening conjunctival injection (mild), orolabial and nostril dryness and fissures, cervical adenopathy, and swollen/painful distal extremities. All of which proved to be unresponsive to acetaminophen, ibuprofen, amoxicillin, and azithromycin as variably dose by the patient’s primary physician during the 7 days prior to referral to our clinic.

PHYSICAL EXAM:
4 y.o. WDWN caucasian boy was alert yet unwilling to communicate (not his norm) and exhibited general lethargy, malaise, ease of irritability, and refusal to interact during the examination.

Mild nonexudative conjunctival injection, severe orolabial/nasal mucosal erythema dryness and bleeding fissures, pharyngeal erythema with a white tonsillar exudate, brilliantly red tongue consistent with “strawberry tongue”, bilateral cervical adenopathy ranging from 0.5 to 1.75cm, nonpruritic fine truncal erythematous maculopapular eruption sparing the distal extremities, and bilateral symmetric tense painful edema of his wrists, hands, ankles, and feet limiting his ability to ambulate and grasp objects. The remainder of the exam was considered within normal limits.

LABORATORY TESTS:

CMP, CBC with differential, UA all within normal limits with exception of mild leukocytosis.

DERMATOHISTOPATHOLOGY: N/A

DIFFERENTIAL DIAGNOSIS:

1.   Viral exanthems
2.   Bacterial diseases (scarlet fever, staphylococcal exfoliative syndromes, and leptospirosis)
3.   Toxoplasmosis
4.   Rickettsial disease (rocky mountain spotted fever),
5.   Mucocutaneous Lymph Node Syndrome