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M. Gómez de Pablos Romero*, M. Sánchez Martín**
*Adjunto de Pediatría de la Clínica Universidad de Navarra (Pamplona), **Adjunto de Pediatría del Hospital Universitario La Paz
36. Fever and rash: outpatient visit
Doctor: Mónica Gómez de Pablos Romero.
Mother: María Sánchez Martín.
Mother: Good morning doctor Evans. I bring Martha in because she has fever and is refusing to eat since yesterday afternoon. I have also noticed a rash in her hands and feet.
Doctor: Good morning, Mrs. Parker. Martha is two years old, right? She is a healthy girl with no past medical history, if I recall correctly?
Mother: That is correct, yes.
Doctor: OK, tell me more about her symptoms. How high has the fever been? Does she have a runny nose, cough, vomiting or diarrhea? Even though she is refusing to eat, is she drinking liquids? Has she stopped peeing?
Mother: The highest temperature has been 38.3ºC. She has had a couple of loose stools since yesterday, no other symptoms apart from that. She is drinking plenty of water and she is peeing as usual.
Doctor: All right. Is anyone else sick at home? Does Martha attend nursery school?
Mother: No, we are all fine. She has been attending nursery school until last week.
Doctor: Very well. Let’s take a look at Martha.
PHYSICAL EXAMINATION
Temperature: 37.8ºC. Good general condition. Well-nourished and hydrated. Capillary refill time: 2 seconds. Maculopapular rash with some small vesicles in hands (dorsum of the fingers, interdigital area and palms), feet (dorsum of the toes, lateral border of the feet, soles and heels) and buttocks. No respiratory distress. Cardiac auscultation: regular, no heart murmur. Pulmonary auscultation: general good bilateral ventilation, no pathological breath sounds. HEENT: hyperemic oropharynx and mildly swollen tonsils, without exudates, vesicles surrounded by a thin halo of erythema in tongue and oral mucosa. Normal tympanic membranes. Small, rubbery, mobile and nontender submandibular and laterocervical bilateral adenopathy. Abdomen: soft, nontender to palpation. No liver edge or spleen felt. No masses. Neurological: awake, alert, normal behaviour.
Doctor: It appears that Martha has hand, foot, and mouth disease. It is a viral disease typically caused by coxsackievirus. It normally lasts from 7 to 10 days.
Mother: OK. What is the treatment?
Doctor: Since it is a viral disease it is self-limited in most cases. You can give Martha ibuprofen and acetaminophen for the fever and pain.
Mother: Perfect, thank you. Is there anything I have to look out for?
Doctor: Make sure that she the pain doesn’t stop her from drinking liquids, if that happens you have to bring her in. If the fever lasts longer than 5 days, she has any difficulty breathing or becomes ill-appearing, you should also have her checked out.
Mother: All right, thank you very much doctor.
KEY WORDS:
Loose stools: deposiciones sueltas.
Plenty: abundante.
Maculopapular rash: exantema maculopapular.
Small vesicles: vesículas pequeñas.
Dorsum (of the fingers): dorso de los dedos.
Soles: plantas.
Heels: talones.
Buttocks: nalgas.
Surrounded: rodeado.
Thin halo of erythema: delgado halo eritematoso.
Hand, foot and mouth disease: enfermedad de mano, pie y boca.
Coxsackievirus: virus coxsackie.
Self-limited: autolimitado.
Meningitis and meningoencephalitis 