Admission Conference

Prime 4 Group 6
Clinical History
Date: October 1, 2019
Informant: Mother
Time of consultation: 10:20 am
% Reliability: 85%
GENERAL DATA
N.S.Q, 9-month old, Female, Filipino, Catholic, born on
May 04, 2018, currently residing at 112 Meton St., Brgy.
Commonwealth, Quezon City
CHIEF COMPLAINT
Rashes
HISTORY OF PRESENT ILLNESS
2 days prior to consult
● Papular lesions on the neck and forehead
● Decrease in appetite
● No other associated signs and symptoms such as fever,
cough, colds, loose stools or vomiting, decrease in activity
● No consult was done.
HISTORY OF PRESENT ILLNESS
1 day prior to consult
● Still had rashes but now spread to the chest area with
accompanying fever which was undocumented
● Still with decrease in appetite
● No other associated signs and symptoms such as cough,
colds, loose stools, vomiting, nor decrease in activity.
● Given Paracetamol 3 mL twice a day.
● Still no consult was done.
HISTORY OF PRESENT ILLNESS
Few hours prior to consult
● Still with rashes and fever (Tmax: 38.9 C) and with
decrease in appetite.
● No other associated signs and symptoms such as cough,
colds, loose stools, vomiting.
● Mother gave Paracetamol 5 mL every 4 hours.
● Due to the persistence of the symptoms, sought consult at
our outpatient department
Lacking in the Clinical History

● Past Medical History

● Family History
● Nutritional History
● Personal and Social History
PHYSICAL EXAMINATION
PHYSICAL EXAMINATION

GENERAL SURVEY: Awake, alert, not in distress

Temp: 39.3 C

Weight: 8.6 kg (2 to 0: Normal) Length: 77.5 cm (3 to 2: Normal)

BMI: 19. 8 (-1 to -2: Normal) IBW: 9.1 kg
TCR:990 cal/day TFR: 1290 cc/day
Age: 9 months
Weight: 8.6 kg
Age: 9 months
Length: 77.5 cm
Age: 9 months
Weight: 8.6 kg
Length: 77.5 cm
PHYSICAL EXAMINATION

HEENT: Pink palpebral conjunctiva, white sclera, intact ear canals, patent nostrils, boggy
turbinates, moist lips and buccal mucosa, pink pharyngeal walls

NECK: Supple neck, no cervical lymphadenopathies

CHEST/LUNGS: Symmetrical chest expansion, no retraction, clear breath sounds, good air entry

HEART: Adynamic precordium, normal rate, regular rhythm, no murmur

ABDOMEN: Slightly globular abdomen, soft, no masses, normoactive bowel sounds, tympanitic

EXTREMITIES: No gross deformities, full and equal pulses, capillary refill time < 2 seconds

SKIN: multiple flesh to pink-colored umbilicated papules, about 2-3mm, neck, scalp, back and
anal area
Salient Features
History
● 9 month old, Female
● Papular lesions on the neck and forehead
● Rashes that spread to the chest area
● Fever (Tmax: 38.9 C)
● Decrease in appetite
● No other associated signs and symptoms such as fever, cough,
colds, loose stools, vomiting, nor decrease in activity
PE
● Fever (T: 39.3 C)
● Boggy turbinates
● Multiple flesh to pink-colored umbilicated papules, about
2-3mm, neck, scalp, back and anal area
Differential Diagnosis
Rubeola (Measles)

Rule In Rule out

● Papular lesions on the ● Maculopapular lesions
neck and forehead ● (-) cough, coryza,
● Rashes that spread to conjunctivitis
the chest area ● (-) Koplik spots
● Fever (Tmax: ● No palpable lymph
38.9-39.3C)
nodes
● Unknown
immunization history
Varicella
Rule In
Rule out
● Fever (Tmax: 38.9 C)
● Papular lesions that ● (-)pruritus
begin on the neck and ● (-)lesions in various
forehead stages of evolution
● Rashes that spread to ● (-)Ulcerative lesions in
the chest area oropharynx,
● Multiple flesh to conjunctiva and
pink-colored genital mucous
umbilicated papules, membranes
about 2-3mm, neck,
scalp, back
Common Warts (Verruca vulgaris)
Rule In Rule out
● 9 month old, Female ● Characteristic of umbilicated
● Presence of flesh to papules
pink colored papules ● Papular lesions on the neck
and forehead
Allergic Rhinitis w/ Atopic Dermatitis

Rule In Rule out

● Rashes that spread to the
chest area
● Boggy turbinates
● (-) cough & colds
● (-) sneezing
● (-) intense pruritus
● (-) trigger factors
● Erythematous papules in
face, scalp, extensor
surfaces usually rashes
spared the diaper area
 Molluscum Contagiosum
Rule In Rule out
● 9 months old ● Cannot be totally
● Papular lesions on the neck ruled out
and forehead
● Multiple flesh to pink-colored
umbilicated papules, about
2-3mm, neck, scalp, back
and anal area
 Admitting Diagnosis
9 months old, female, Molluscum Contagiosum
Discussion
Molluscum Contagiosum
● Large double-stranded DNA virus
● Flesh-colored, dome-shaped papules on
the skin
● Has 4 subtypes
● MCV-1 virus causes most infections
● Acquired by direct contact with infected
person or from fomites
● Humans are the only source of contact
● Incubation: 2 weeks or longer
● Resolves within 6-12 months without
scarring, but may take as long as 4
years
Molluscum Contagiosum
Risk Factors:
● Occurs in healthy adolescent and adult: most common 1 to 10 years of age
● Immunodeficient states
○ Cellular immunodeficiency, HIV infection, treatment with
immunosuppressive drugs
● Living in warm, humid climates: living conditions are crowded
● Atopic dermatitis

Transmission

● Spread by direct skin to skin contact (Autoinoculation)

○ Scratching or touching a lesion
● Fomites
● Sexual contact
Molluscum Contagiosum
Clinical Manifestations

● Discrete, pearly, skin-colored, dome-shaped

papules (1-5 mm)
● Central umbilication from which a plug of
cheesy material can be expressed
● Sites of predilection are the face, eyelids,
neck, axillae, and thighs
● May be found in clusters on the genitals or
in groin of adolescents and may be
associated with other venereal diseases in
sexually active individuals
Molluscum Contagiosum
Clinical Manifestations

● Lesions on AIDS patients: large and numerous particularly on the face

● Leukemia and other immunodeficiencies: Exuberant lesions may be
found
● With atopic dermatitis: Widespread involvement on areas of
dermatitis
Molluscum contagiosum
Treatment

● Self-limited disease
● Should advise to avoid shared bath towels until infection is cleared
● Immunotherapy with candida or trichophyton antigen
○ Repeated every 4 weeks until resolution
● Liquid nitrogen cryotherapy
● Cantharidin: for younger children
Management
 DIET
● Continue breastfeeding until 2 years of age
● Complementary feeding

DIAGNOSTICS
● Microscopic Identification
○ White waxy material, intracytoplasmic molluscum bodies with
Wright or Giemsa stain
○ Diagnostic: rounded, cup-shaped mass of homogenous cells,
with identifiable lobules
DRUGS
● Self-limiting infection
● Immunotherapy with candida or trichophyton antigen
○ Most commonly used treatment
● Topical Steroids
○ Canthadrin
○ 5% imiquinod cream
● Oral antihistamine
○ Cetirizine 2.5mg oral drops QD
DISPOSITION
● Proper handwashing of caregiver
● Ensure proper hygiene of the patient
● Advised to avoid shared baths and towels
● Apply moisturizing lotion after bathing
● Catch up immunizations
● Advise on appropriate follow up
 Thank you!
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