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


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


CRP: 16

ESR: 18


Rubeola Titer: still Pending

What would you do next?