Teenager With Fever, Pharyngitis, and Generalized Rash

THE CASE: A previously healthy 16-year-old boy presents for evaluation of a slightly pruritic, nontender, generalized rash. His father reports that the onset of the rash 3 days earlier was associated with tactile fever, pharyngitis, headache, poor appetite, nausea, abdominal pain, and bilateral knee and elbow pain. These symptoms resolved; however, the rash has persisted and the skin of the face, neck, forearms, and upper chest has started to desquamate.

The patient has no sick contacts and does not take any medications. He states that he began using a new shampoo a week earlier; however, the rash does not involve his scalp. He has no history of hospitalizations or surgeries and is up-to-date with his immunizations.

Generalized erythema with desquamation is noted on the lips, neck, axillae, antecubital fossae bilaterally, groin, and lower extremities. The tongue is bright red without exudates. Conjunctivae are slightly injected with no ocular discharge. Cardiac, pulmonary, abdominal, and musculoskeletal findings are normal. There is no lymphadenopathy and no hand or foot edema.

What do you suspect?

•Scarlet fever
•Staphylococcal exanthema
•Viral exanthema
•Drug reaction

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