Diagnostic Dilemma

Fever, rash and convulsions

A 2½ years old boy born of third degree consanguineous marriage presented with fever since 6 days and maculopapular rash since 2 days. He had a generalized tonic clonic convulsion 2 hours back with post ictal drowsiness. There is no otorrhoea, vomiting or focal neurological deficit. On examination, he was febrile, had tachycardia (120/min) with B.P. of 90/60 mm of Hg and was drowsy. There were no cranial or focal neurological deficit and deep tendon reflexes were brisk with extensor planters. He had erythematous maculopapular rash over face and extremities and a soft hepatomegaly. There were no meningeal signs. Tache Cerebrale sign was negative. The child was treated with antibiotics and acyclovir.

What is the likely diagnosis?
Expert Opinion :
This child has presented with fever, rash, convulsion and hypotension. He does not have any meningeal signs and Tache Cerebrale sign is also negative ruling out meningitis clinically. However, the child could have viral encephalitis. The commonest viral infection that can cause rash along with fever is dengue, rubella, measles. However, this child has already received measles and rubella vaccine. Thus the possibility of dengue should be kept in this child. Investigations in this child showed thrombocytopenia with normal electrolytes and normal CSF examination. His Dengue IgM was positive by Panbio test. Dengue can lead to encephalitis with normal CSF and viral encephalitis may be a presentation of dengue.
Answer Discussion :
hayat kishk
Herpetic encephalitis
5 years ago
Roberto sangermani
5 years ago

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