A history taking – Dec 15, 08
23/M/Female, an IPTS student
Maculo-papular rash on limbs x 1/7
Hx of presenting complaint:
Maculo-papular rash x 1/7 over all four limbs. No rash on the trunks. Bright red in colour. Non-itchy. Painless. Not getting worse with exposure to sunlight.
Facial flush – diffuse, bright red on the cheeks.
4days ago, had a high-grade fever x 3/7. Initially did not improve with PCM. Fever subsided spontaneously and abruptly after 3 days.
No other symptoms of URTI
Severe myalgia and arthralgia – predominantly on small joints, wrist, ankle and knee joints. Occasionally on shoulder and lower back. Unable to sleep at night due to pain.
Swollen hands and feet.
Headache – throbbing in nature. No retro-orbital pain.
No abdominal pain, vomiting or change in bowel habit. Did not notice any yellow sclera.
Reduced appetite, but still can tolerate orally. No lethargy. But feels dehydrated.
PU is normal. No urinary symptoms.
No spontaneous bruising, no gum bleeding.
Never had similar symptoms before. No hx of direct contact with patient with similar symptoms. No h/o contact with animals or open water source. Not eating outside recently. Se*ual hx unremarkable. Not in contact with used needles.
Past Medical Hx:
NKMI. No hx of hospitalisation.
Drug hx: Not on any regular medication. NKDA.
Family hx: Insignificant.
Social hx: IPTS student. Never smokes or drinks. Non IVDU. Had hx of travelling to the area of common case of dengue. Chikungunya also has been reported. She didn’t know any case of dengue or chikungunya reported while she was there. But there was frequent fogging activity in that area.
PR=80bpm, BP=97/68mmHg, T=37.2 C
Diffuse maculo-papular rash on all four limbs and neck with the presence of ‘isles of white in a sea of red.’
The rash blanches on pressure.
No conjunctival pallor or jaundice.
Dry tongue and mucous membrane.
Submental, submandibular and jugular chains LN are palpable, firm, mobile and tender.
No abdominal distension, palpable abdominal mass, or organomegally.
Diffuse swelling of hands and feet. Slight tender, but no pitting.
PIP, MCP, wrist, IP, MTP and ankle joints are tender. No stiffness.
Hess’ (tourniquet) test is negative.
FBC: Hb=13.9, WBC=4.0, HCT=40.8%, Plt=151