02-06-2008, 01:57 PM
You are called to the emergency department to evaluate a 6-year-old girl who has developed a rash on her distal extremities 2 days ago that has been progressing toward her trunk. She has had a fever and arthralgias over the past 2 days for which she was given acetaminophen. On further questioning, the patient's mother reports that the patient was bitten by her pet rat a few days prior to onset of the fever and rash; however, the site appears to be healing well. Her mother reports that the girl has a normal past medical history without any significant health problems. Laboratory studies show leukocytosis with an elevated neutrophil count. Blood culture results are pending. At this time the most correct statement about this patient's condition is:
A. Her rash is classic for Rocky Mountain Spotted Fever and she should be started on antibiotics for rickettsial organisms
B. Meningitis can be ruled out because the rash usually starts on the trunk and extends peripherally
C. The patient should be admitted and started on broad-spectrum antibiotics to cover Streptobacillus moniliformis and Spirillum minor
D. This is a drug eruption secondary to acetaminophen and you should advise the patient's mother to stop acetaminophen and give ibuprofen instead
E. This is most likely a viral exanthem and will resolve spontaneously in 1-2 weeks
A. Her rash is classic for Rocky Mountain Spotted Fever and she should be started on antibiotics for rickettsial organisms
B. Meningitis can be ruled out because the rash usually starts on the trunk and extends peripherally
C. The patient should be admitted and started on broad-spectrum antibiotics to cover Streptobacillus moniliformis and Spirillum minor
D. This is a drug eruption secondary to acetaminophen and you should advise the patient's mother to stop acetaminophen and give ibuprofen instead
E. This is most likely a viral exanthem and will resolve spontaneously in 1-2 weeks
