Kayla brings Riley, now 17 months, in for complaint of fever
and rash. The fever began “a couple of days ago” and is of normal levels in the morning then gets as high as 103 to 104 degrees in the afternoons. Riley has also had clear rhinorrhea and in the last 24 hours he has developed a red, diffuse rash to the torso and abdomen that does not itch and a dry cough
in the last day. Mother reports he is drinking, but not as well as usual. He did have a good wet diaper this morning, but is not really eating much and is not playing.
Physical Examination Riley:
V/S: Height: 81 cm, Weight: 13 kg, B/P: 94/60, T: 100.6, HR: 114 BMP/reg., Resp: 28, reg, non-labored, SpO2: 97%
General: somewhat lethargic and cries some throughout exam. SKIN: Diffuse erythemamtous rash in fine popular patches across the torso and very erythematous to the cheeks. HEENT: Head normocephalic atraumiatic. Conjuctiva clear, non-icteric, but mildly injected PERRL. Unable to complete fundoscopic exam. Tympanic membranes intact with scant clear fluid posteriorly bil and mild injection. EAC unremarkable. Pinna/tragus w/o tenderness. Nares patent, mucosa mildly injected with sl. edema to the inferior and medial turbinates bil, moderate clear rhinorrhea. Pharynx with mild slight erythema, tonsils 2/4 bil. Oral exam unremarkable. Neck supple w/mild anterior cervical lymphadenopathy bil. Thyroid small, firm, equal bil. CARDIOPULMONARY: Heart RRR w/o murmur. Lungs with mild expiratory wheeze in posterior bases. Respirations even and unlabored. Abdomen rounded normoactive bowel sounds throughout, soft, non-tender, no masses or organomegaly.
Lab: WBC 6.9, Lymph 50%, Neutrophils 40%, Monocytes 6%, Eosinophils 3%
What are my differentials