A 5-year-old boy is brought to the pediatrician with a 4-day history of high fever, cough, runny nose, and red eyes. His mother reports that he developed a rash yesterday that started on his face and has now spread to his neck and trunk. Past medical history is negative, and he does not take any medications. He has not had any recent travel or known contacts with anyone who has been ill. Vital signs show a temperature of 102°F (38.9°C) but are otherwise within normal limits. On physical examination, the child appears ill, and a maculopapular rash is noted on his face, neck, and trunk. Upon inspection of the oral cavity, small white spots are observed on the buccal mucosa.
C) Measles
Measles presents with high fever, cough, rhinorrhea, and conjunctivitis followed by a maculopapular rash beginning on the head and neck which spreads downward to cover the trunk. Koplik spots, which are white spots on the buccal mucosa, may be seen 3 days after the onset of symptoms. The clinical presentation and the presence of Koplik spots in this child are characteristic of measles.
Answer choice A: Chickenpox, is incorrect. Chickenpox presents with a vesicular rash that appears in crops and is typically associated with mild fever and malaise.
Answer choice B: Hand-foot-and-mouth disease, is incorrect. Hand-foot-and-mouth disease presents with oral ulcers and a vesicular rash on the hands and feet, not a maculopapular rash spreading from the head and neck.
Answer choice D: Rubella, is incorrect. Rubella presents with a similar rash but is usually associated with milder symptoms and does not have Koplik spots.
Answer choice E: Scarlet fever, is incorrect. Scarlet fever presents with a sandpaper-like rash and is associated with a sore throat and strawberry tongue, not Koplik spots.
Key Learning Point
Measles presents with high fever, cough, rhinorrhea, and conjunctivitis followed by a maculopapular rash beginning on the head and neck which spreads downward to cover the trunk. Koplik spots, which are white spots on the buccal mucosa, may be seen 3 days after the onset of symptoms.
