Burnham, Carey-Ann D

Dunne, W. Michael, Jr.

Storch, Gregory A

Watson, Michael E, Jr.

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Washington University School of MedicineDigital Commons@BeckerOpen Access Publications2011Photo Quiz: A 2-year-old female with fever andrashMichael E. Watson Jr.Washington University School of Medicine in St. LouisGregory A. StorchWashington University School of Medicine in St. LouisW. Michael Dunne Jr.Washington University School of Medicine in St. LouisCarey-Ann D. BurnhamWashington University School of Medicine in St. LouisFollow this and additional works at: http://digitalcommons.wustl.edu/open_access_pubsThis Open Access Publication is brought to you for free and open access by Digital Commons@Becker. It has been accepted for inclusion in OpenAccess Publications by an authorized administrator of Digital Commons@Becker. For more information, please contact engeszer@wustl.edu.Recommended CitationWatson, Michael E. Jr.; Storch, Gregory A.; Dunne, W. Michael Jr.; and Burnham, Carey-Ann D., ,"Photo Quiz: A 2-year-old femalewith fever and rash." Journal of Clinical Microbiology.49,7. 2389. (2011).http://digitalcommons.wustl.edu/open_access_pubs/2354  10.1128/JCM.00081-11. 2011, 49(7):2389. DOI:J. Clin. Microbiol. Dunne Jr. and Carey-Ann D. BurnhamMichael E. Watson Jr., Gregory A. Storch, W. Michael A 2-Year-Old Female with Fever and Rashhttp://jcm.asm.org/content/49/7/2389Updated information and services can be found at: These include:CONTENT ALERTS more»articles cite this article), Receive: RSS Feeds, eTOCs, free email alerts (when newhttp://journals.asm.org/site/misc/reprints.xhtmlInformation about commercial reprint orders: http://journals.asm.org/site/subscriptions/To subscribe to to another ASM Journal go to:  on March 8, 2014 by Washington University in St. Louishttp://jcm.asm.org/Downloaded from  on March 8, 2014 by Washington University in St. Louishttp://jcm.asm.org/Downloaded from JOURNAL OF CLINICAL MICROBIOLOGY, July 2011, p. 2389 Vol. 49, No. 70095-1137/11/$12.00 doi:10.1128/JCM.00081-11Copyright © 2011, American Society for Microbiology. All Rights Reserved.Photo Quiz(For answer and discussion, see page 2784 in this issue [doi:10.1128/JCM.r00081-11])A 2-Year-Old Female with Fever and RashA previously healthy 2-year-old Caucasian female fromsoutheast Missouri presented to the emergency department ofSt. Louis Children’s Hospital in June 2010 with a week-longfever. Her history included the removal of a small tick en-gorged with blood several days prior to fever onset. She exhib-ited high fevers of up to 104°F, with associated rhinorrhea, amild cough, and episodes of emesis and diarrhea causing mod-erate dehydration. After several days at home, she was admit-ted to the hospital, where she was treated with ceftriaxone andazithromycin for otitis media without overall improvement.She developed an erythematous, maculopapular rash thatblanched with pressure and that initially began on her cheeksand then spread down her neck to her trunk and extremities,sparing her palms and soles; no petechiae were observed. Acomplete blood count (CBC) revealed a low-normal whiteblood cell (WBC) count of 4.9  109 cells/liter, a (low) hemo-globin concentration of 10.9 g/dl, and a low platelet count of102  109 cells/liter. Her serum metabolic panel indicatedhyponatremia (133 mmol of sodium/liter) with mildly elevatedliver transaminase levels (asparatate transaminase [AST], 56U/liter; alanine transaminase [ALT], 48 U/liter). Routine bac-terial cultures of blood and urine were negative for growth.After further evaluation, a lumbar puncture was performed,with analysis of cerebrospinal fluid (CSF) showing a total cellcount of 95 106 cells/liter, with a nucleated cell count of 93106 cells/liter, including 84% lymphocytes and 13% monocytes;the CSF glucose level was 52 mg/dl, and the CSF protein level was53 mg/dl. Geimsa staining of the CSF specimen was performed aspart of her evaluation and revealed inclusion bodies present in thecytoplasm of monocytes (Fig. 1). A PCR assay of whole blood wasperformed and confirmed the diagnosis.Michael E. Watson, Jr.Gregory A. StorchDepartment of PediatricsWashington University School of MedicineSt. Louis, Missouri 63110W. Michael Dunne, Jr.Department of Pathology & ImmunologyWashington University School of MedicineSt. Louis, Missouri 63110Carey-Ann D. Burnham*Departments of Pediatrics and Pathology & ImmunologyWashington University School of Medicine660 S. Euclid Ave., Box 8116St. Louis, Missouri 63110*Phone: (314) 747-5185Fax: (314) 454-2274E-mail: Burnham_c@kids.wustl.eduFig. 1. Wright-Geimsa stain of cerebral spinal fluid from the patient, showing cytoplasmic inclusion bodies within monocytes (originalmagnification, 1,000).2389 on March 8, 2014 by Washington University in St. Louishttp://jcm.asm.org/Downloaded from 

Photo Quiz: A 2-year-old female with fever and rash

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Photo Quiz: A 2-year-old female with fever and rash

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