Course 1 Case 4
Case report 1-4E: A 6-year-old girl with fever, sore throat and rash
Family history: Father treated for high blood pressure, mother healthy, sister 3ys healthy. Personal history: Perinatal data: child of 1 st pregnancy, physiological, spontaneous in term delivery, head presentation, 3350g/50cm, no resuscitation, physiological icterus, breast-fed 4 months, hip joints with no dysplasia, vaccinated according schedule. No severe illness before, only common colds. No injury, operation - nasal adenotomy in 3ys of age. No regular medication. No known allergy. Fair social conditions, attends a kindergarten. Current illness: Yesterday the girl was tired, complained of abdominal pain and sore throat, at night she got fever 39 o C, was given paracetamol 200mg. This morning fever again 38,5 o C, sore throat, mother noticed some rash on the abdomen. Physical examination: T 38 o C, girl conscious, responds adequatelly, complains of sore throat and mild headache. On the skin of the abdomen and axillae there is tiny maculopapular rash of red colour, confluent, slightly itching, with blanching under pressure or scratching. Face erythem with circumoral pallor, reddened throat and palatal tonsills, white tongue. Mild bilateral submandibular lymphadenopathy, slightly painful. Eupnoic, normal lung and heart sounds, HR 100/min, BP 90/60. Abdomen soft, no resistance, not tender, no hepatomegaly, no splenomegaly. Meningeal signs negative. Questions: 1.
What is the likely diagnosis? 2.
What is the etiological agent? 3.
In what material and what test can isolate the pathogen? What other diseases can the pathogen cause? What does cause the skin a mucosal signs in this disease? 6.
What are the basic therapeutical principles? Pathology: Febris rheumatica Pathophysiology: Fever, its specific features and considerations in childhood