Sore Throat and Widespread Rash in a Young Sailor
A young naval recruit presents with a cluster of symptoms that may sound familiar. Get more clues and a close look at the rash, here.
Patient is a 19-year-old who presents with several days of fever, sore throat, fatigue.
He describes body aches and being unable to socialize because of exhaustion. Tonsils were removed at age 5 years because of recurrent sore throats.
Patient denies sexual activity, exposure to infectious diseases, taking medication; current on all immunizations.
Physical exam: Very inflamed anterior tonsillar pillars; no enanthem noted.
Physical examination: moderately tender jugulodigastric lymph nodes bilaterally; diffuse morbilliform rash over his entire body.
Physical examination; erythematous maculopapular rash on arms.
Physical examination: spleen tip is palpable. What is the differential diagnosis for morbilliform eruptions?
Common sources of morbilliform eruptions are viruses (eg, rubella, roseola, erythema infectiosum); drugs (eg, penicillin, NSAIDs, salicylic acid); bacteria (eg, scarlet fever)
Sources of morbilliform eruptions: Reactive erythemas, papulosquamous disorders.
Considering physical findings and history, what labs would you order? CBC with differential, Monospot, liver function, all of the above, none of the above
Recommended laboratory studies: CBC with differential, Monospot, liver function. Monospot positive; CBC revealed lymphocytosis with 60% atypical lymphs.
What is your diagnosis?
Diagnosis: infectious mononucleosis. Throat culture confirmed group A streptococci; also noted is anicteric hepatitis; rash is seen in 10 to 15% of patients with mononucleosis.
As many as 50% of patients will have puffy eyelids during the first week of the illness.
Reminder: enanthem appears in about 25% of patients between the 5th and 17th day of infection.
What is the STAR complex?
STAR Complex: Sore Throat, Arthritis, Rash (eg, Parvovirus B19, hepatitis B, adenovirus, echo viruses)
A 19-year-old naval recruit was in his usual state of good health until 4 or 5 days ago when he presented with a bad sore throat, fatigue, "achiness," and a diffuse morbilliform rash. The symptom cluster may sound familiar. A few more clues and a good look at the rash are included in the slide show above.
