Fever and Rash Diagnosis
What's your diagnosis?
Meningococcemia. Purpuric rash in a 3-year-old. The classic presentation of meningococcemia is the acute onset of fever in association with petechiae or purpura. Headache, myalgia, nausea, and vomiting may be present. Altered mental status, photophobia, and neck stiffness suggest meningitis. Tachycardia, hypotension, and poor perfusion are evidence of septic shock. Early in the course of disease, the rash can appear as a nonspecific, erythematous, maculopapular rash that blanches (Figure 97-5), followed by rapid progression to petechiae and purpura (Figure 97-6). Rash may be absent in a minority of cases.