1e. A patient with fever, headache, bodyache and rash

Case history- A 18 year’s boy presents with 5 days fever with headache and bodyache. He notices red rash over the body.

What would you consider as differential diagnosis?

Dengue fever

Measles

Meningococcal septicemia

Drug rash with fever

What key questions would you ask?

• Fever- Sudden onset of pyrexia, saddle back fever^*
• Severe body pain, headache, severe eye pain
• History of residing or traveling to urban area.
• History of rash-maculopapular rash in dengue and measles, purpuric rash in
• Meningococcal septicemia and bleeding from mucosal surface like gum- dengue fever.
• Neck stiffness- meningococcal meningitis
• Drug history

What will you examine?

          General examination- Patient is ill looking; temperature is raised.

Maculopapular rash

Distribution of rash-

Rash more in trunk, also involve palm and sole- dengue fever

Rash involving hair line and behind ears- measles

Purpuric rash more in lower limb- meningococcal septicemia

Tourniquet test^**– positive in dengue fever

Systemic examination- no abnormality or organomegaly.

Clinical diagnosis- Dengue fever

Investigation- Blood for TC, DC, Hb%, ESR and Platelet count- may be normal or reduced platelet count.

PCV (Haematocrit) – may be raised.

Treatment-

Mild-

Reassurance

Bed rest.

Paracetamol 0.5-1 g 4-6-hourly.

ORS orally

Moderate to severe dengue fever- referred to hospital.

*Saddle back fever- fever reappears after remission.

**Tourniquet test- wrap cuff of sphygmomanometer in arm and mark one square inch in anticubital fossa. Inflate cuff and keep it between systolic and diastolic pressure for 5 minutes and then release. If more than 10 purpura appear within one square inch, test is positive.