26: Rash & Fever

You are working in a double-covered ED when your colleague asks you for a second opinion on a rash. The patient is a 43 year old businessman who complains of fever, rash, headaches and body aches. All of his symptoms wax and wane, and have been present for the past 3 days. On exam he is non-toxic with normal vitals except for an oral temperature of 101.8. The rest of his exam is unremarkable except for the rash, which is all over his body, and is shown below.

You ask the patient one question and nail the diagnosis. Of course it helps that your friend recently had the same condition. What is the question? What is the diagnosis? Hint: His only abnormal lab is a white count of 1.7.

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Answer: The question is “Where have you been recently?”  The disease is Dengue.                            Excerpt on Dengue Fever from

“QUICK ESSENTIALS: EMERGENCY MEDICINE“

Epidem: Tropical urban Aedes mosquito bites during day, flavivirus, incubation 4-7d
Sx/Sn: AKA”Brakebone Fever”: F, HA, eye-back-bone pain, GI, bleed, dehydration, mac/pap/petechial rash.
Comps: Hemorrhage, petechiae, low plates, shock, hepatitis, CNS bleed, myocarditis, retina
Labs: Leukopenia, thrombocytopenia, LFT’s. IgM EIA + by day 4-5 of dz, PCR + day 1-4
Rx: IV Fluids, Supportive