new_n_lost
Politically InCorrect
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A 7-year-old boy is brought to a physician because of a nearly confluent,fine, erythematous, macular rash that is most pronounced on his trunk. He has had a mild fever for 36 hours, but does not appear very sick, and is happily playing when the pediatrician enters the examining room.
Physical examination demonstrates a reddened throat with tonsillar exudates, enlarged cervical nodes including the occipital node, and questionable splenomegaly. The mother says that the boy has not been coughing, and no Koplik spots are noted.
Which of the following is the most likely diagnosis?
A. Bullous pemphigoid
B. Dermatitis herpetiformis
C. Herpes simplex
D. Measles
E. Rubella
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| yoga
usmlelogy professor
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can not b measles=>no koplik spots
is it rubealla?
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| medocuk
IM-RES
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I will still go for Measles. More out of exclusion than anything else.
Also it has the prodromal phase, rash, distributions and lymph node involvement. But I am not sure. Will check and come back to you.
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| simi
Forum Elite
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E
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| keepgoing
Forum Guru
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seems ,rubellla only
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| po
Forum Elite
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cervical nodes including the occipital node,=E. Rubella 
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| new_n_lost
Politically InCorrect
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yoga wrote:
can not b measles=>no koplik spots
is it rubealla?
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| new_n_lost
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The correct answer is E.
This presentation (fine, nonblotchy, truncal rash in a not-very-ill child) is characteristic of rubella, or German measles. IgM specific for rubella can often be detected in serum within 1-2 days of developing the rash. The principal significance of this disease is that it can cause a devastating congenital infection characterized by ocular problems (cataracts, retinopathy, microphthalmos, glaucoma), cardiovascular problems (patent ductus arteriosus, ventricular septal defect, pulmonary stenosis), deafness, thrombocytopenic purpura, hepatosplenomegaly, CNS problems, and bony lesions.
Bullous pemphigoid (choice A) produces large, tense blisters.
Dermatitis herpetiformis (choice B) causes recurrent crops of small vesicles or papules.
Herpes simplex (choice C) is characterized by crops of vesicles on oral or genital sites.
Measles (choice D) causes a blotchy, maculopapular erythematous rash that begins on the face and spreads downward. Patients with measles are usually much sicker than those with German measles, and Koplik spots maybe seen on the buccal mucosa.
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FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
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| medocuk
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thanks. 
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| amritt786
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hi my question is is this herpes simplex or herpes virus if it is herpes simplex i mark rubbela. but in rubella no splenomegaly, rash start from hairline.
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| edie
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Maybe that's why the splenomegaly was "questionable" 
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| Ig F
Forum Elite
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where did spleenomegaly come from in Rubella...it can only be present if itz congenital but here we rnt talking about congenital rubella.........
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| bactitech
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I am old ehough (58) to have experienced both Rubella and the "real" measles. Rubella was just a rash. I was in early grade school when I got it. I don't remember being very sick.
I was four years old (1953) when I had the real deal. I was very very ill. I had a high temperature for quite awhile - 104 according to my mother. My face puffed up from the rash. Only reason I know this is my mother took pictures. I had to be in a dark room because my eyes were sensitive to light. According to my mom I was sick for nearly two weeks. I was a chubby child before this illness. Pics of me after the illness show a peaked child who had lost quite a bit of weight. Luckily I had no known after affects. It is a very good thing kids don't have to experience this disease any more.
http://en.wikipedia.org/wiki/Measles
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