History of Present Illness:
A patient in their late teens presents to the hospital with family for 2 days of sore throat, fever, vomiting and most recently a rash on his elbows and knees. He denies abdominal pain, diarrhea or other complaints. He has no significant PMH.
Vital Signs & Physical Exam:
Vital signs are normal. Physical exam is also normal except for exudative pharyngitis and the rash shown below
What is the most likely diagnosis?
- A) Group A Strep
- B) Group B Strep
- C) CMV
- D) EBV
SCROLL DOWN FOR ANSWERS & 1-MINUTE CONSULT
<<<<<<<<<<<<<<<<<<<<< ADVERTISEMENT & SPACER >>>>>>>>>>>>>>>>>>>>>
THE EMERGENCY MEDICINE POCKETBOOK TRIFECTA
Emergency Medicine 1-Minute Consult, 5th edition
A-to-Z EM Pharmacopoeia & Antibiotic Guide, NEW 5th edition
8-in-1 Emergency Department Quick Reference, 5th edition
******************************************************************************
<<<<<<<<<<<<<<<<<<<<<<<<< END SPACER >>>>>>>>>>>>>>>>>>>>>>>>>
QUIZ ANSWER: What is the most likely diagnosis?
- A) Group A Strep – can cause scarlet fever, but this rash is atypical as is the patient’s age (usually 5-15)
- B) Group B Strep – can mimic strep throat and often in sexually active men with female partners, but rash unlikely
- C) CMV – good thought but more likely EBV
- D) EBV – CORRECT – rash more classic after amoxicillin but can occur without antibiotics as well
1-Minute Consult on this topic: Click HERE and scroll to page 79.
CASE CONCLUSION: mono-spot was positive. Rapid strep was negative. Rash resolved two days later but sore throat took longer
***