Isla, a 15-Month-Old Girl with Fever and Rash

Abstract

CASE PRESENTATION You are the admitting physician when Isla, a previously healthy 15-month-old girl, presents to the emergency department (ED) with 7 days of fever, mild congestion, cough, and a new rash. Two days ago, Isla was seen by her pediatrician and diagnosed with a viral illness. Her mother brought her to the ED today because of the development of the rash. In the ED, Isla is noted to be pale, inconsolably irritable, and refusing oral intake. The ED physician obtains a chest radiograph, which is normal. Blood work, including culture, complete blood cell count (CBC) with differential, C-reactive protein (CRP) level, erythrocyte sedimentation rate (ESR), and comprehensive metabolic panel (CMP), is ordered and is pending. Additionally, the ED physician obtains a respiratory panel by polymerase chain reaction (PCR) and a urinalysis (UA). Given Isla’s ill appearance and the need for further monitoring and evaluation, the ED physician calls you to evaluate her for admission.