CASE HISTORY

Name; Zozo Stephanovich

Age: 6 years old
Date of birth; 23/06/2014

COMPLAINTS
Main: The main complaints the parents presented to us were a mild fever, small
blisters on her shoulder and chest, headache sore throat.

Secondary complaints: abdominal pain, cough and malaise,

ANAMNESIS MORBI
Preceding skin manifestations after mild fever which was 1-2 days. Parents believe
she might have contacted illness from school.

ANAMNESIS VITAE
Child has not had this bvefore this is the first time. House hold conditions of the
child are satisfactory. Feeding before illness was normal and good.

ALLERGOLOGICAL HISTORY
No presence of allergic symptom, child has also no intolerance to any product, so
far she hasn’t had any reaction to any drug she has taken
 EPIDEMIOLOGICAL HISTORY
Child may have come in contact with infected person from school. Diarrhea is
absent.

THE SKIN AND MUCUOUS MEMBRANE

The skin has present small bumps, and also thin-walled blisters filled with fluid.
Surface of skin is very rough and dry due to bumps on skin. Elasticity is quiet
normal.
Aside that all systems are normal and good.

PLAN OF EXAMINATION

 Polymerase chain reaction (PCR) testing. The most sensitive method

for confirming a diagnosis of varicella is the use of PCR to detect VZV in
skin lesions (vesicles, scabs, maculopapular lesions).
 IgM testing. IgM testing is considerably less sensitive than PCR testing
of skin lesions; commercial IgM assay may not be reliable and false
negative IgM results are not uncommon; a positive IgM ELISA result,
although suggestive of a primary infection, does not exclude re-infection
or reactivation of latent VZV.
 Paired acute and convalescent sera. Paired acute and convalescent sera
showing a four-fold rise in IgG antibodies have excellent specificity for
varicella, but are not as sensitive as PCR of skin lesions for diagnosing
varicella.
 Blood testing. Most children with varicella have leukopenia in the first 3
days, followed by leukocytosis; marked leukocytosis may indicate a
secondary bacterial infection but is not a dependable sign; significant
elevations of alanine aminotransferase (ALT) occur.
 DIFFERENTIAL DIAGNOSIS

Common Conditions Features

Coxsackievirus

The most commonly caused disease is the Coxsackie A disease, presenting as

hand-foot-mouth disease. It may be asymptomatic or cause mild symptoms. There
may be fever and painful blisters in the mouth (herpangina), on the palms and
fingers of the hand, or on the soles of the feet. There can also be blisters in the
throat or above the tonsils. Adults can also be affected. The rash, which can appear
several days after high temperature and painful sore throat, can be itchy and
painful, especially on the hands/fingers and bottom of feet.

Stevens-Johnson syndrome

The symptoms may include fever, sore throat and fatigue. Commonly presents as
ulcers and other lesions in the mucous membranes, almost always in the mouth and
lips but also in the genital and anal regions. The lesions in the mouth are extremely
painful and reduce the patient's ability to eat or drink. Conjunctivitis of the eyes
occurs in about 30% of children. A rash measuring about an inch across, may arise
on the face, trunk, arms and legs, and soles of the feet, but usually not on the scalp.

Kawasaki disease

Commonly presents with high and persistent fever, red mucous membranes in
mouth, "strawberry tongue", swollen lymph nodes and skin rash in early disease,
with peeling of the skin of hands, feet and genital area.

Measles

Prodrome of high fever, cough, coryza and conjunctivitis, with oral mucosal
lesions (Koplik's spots), followed by widespread skin rash.

Rubella
Commonly presents with a facial rash which then spreads to the trunk and limbs,
fading after 3 days, low grade fever, swollen glands, joint pains, headache and
conjunctivitis. The rash disappears after a few days with no staining or peeling of
the skin. Forchheimer's sign occurs in 20% of cases, and is characterized by small,
red papules on the area of the soft palate.

Cytomegalovirus

The common symptoms include sore throat, swollen lymph nodes, fever, headache,
fatigue, weakness, muscle pain and loss of appetite.

Meningococcemia

It commonly presents with rash, petechiae, headache, confusion, and stiff neck,
high fever, mental status changes, nausea and vomiting.

Meningitis

It commonly presents with headache, nuchal rigidity, fever, petechiae and altered
mental status.

Rocky Mountain spotted fever

The symptoms may include maculopapular rash, petechial rash, abdominal pain
and joint pain.

Molluscum contagiosum

The lesions are commonly flesh-colored, dome-shaped and pearly in appearance.

They are often 1-5 millimeters in diameter, with an umblicated center. Generally
not painful, but they may itch or become irritated. Picking or scratching the lesions
may lead to further infection or scarring. In about 10% of the cases, eczema
develops around the lesions. They may occasionally be complicated by secondary
bacterial infections.

Mononucleosis

Common symptoms include low-grade fever without chills, sore throat, white
patches on tonsils and back of the throat, muscle weakness and sometime extreme
fatigue, tender lymphadenopathy, petechial hemorrhage and skin rash
CLINICAL DIAGNOSIS
Chicken Pox

TREATMENT

Pharmacologic Therapy
The symptoms of chickenpox in the pediatric population can be treated topically
and with oral agents.

(a)Antiviral therapy. The routine use of acyclovir or valacyclovir in healthy

children is recommended by the AAP if it can be given within 24 hours after the
rash first appears in children older than 12 years, those with chronic cutaneous or
pulmonary disorders, those on long-tern salicylate therapy, and children receiving
corticosteroids.
(b)Varicella zoster immune globulin. Varicella zoster immune globulin (VariZIG
by Cangene) (ideally within 4 days) of chickenpox exposure; this agent reduces
complications and the mortality rate of varicella, not its incidence.
©Antibiotic therapy. Suspicion of secondary bacterial infection should prompt
early institution of empirical antibiotic therapy until the results of culture studies
become available.