Here’s a new case.
4 yo boy
HPI: Previously healthy 4 yo boy with 5 days of fever to 104, coryza, rhinorrhea, headache. No sore throat, no vomiting, no diarrhea. Poor appetite, but drinking well. No sick contacts.
PMHx: no meds, surgeries or hospitalizations. Vaccines UTD
Social history: lives with mom, dad, 2 sibs (both healthy), no smoke exposure. No day care
PE:
Mildly ill appearing; copious coryza, clear rhinorrhea. Conjunctivitis with limbic sparing; TMs, OP wnl. Shotty anterior cervical lymphadenopathy. Lungs CTA, CV hyperdynamic precordium, no murmurs appreciated. Skin: large erythematous macule on right cheek – no induration, no warmth – appears non painful to palpation. Palmer erythema, no vesicles; erythema of arms; peeling around lips; strawberry tongue;
My plan: I saw him on Monday — felt it was viral and to RTC if not better — mom called Tuesday morning — had fever to 106. Saw him again, same exam. Looked worse, midly dehydrated. So I ordered the following labs:
CBC: WBC 8.0; Hgb 12.8; Platelets 338
CMP: WNL
CRP: 16
ESR: 18
U/A: WNL
Rubeola Titer: still Pending
What would you do next?