Question of the Week # 476

476. You are evaluating a 12 month old male patient for rhinorrhea and poor appetite. He is friendly and alert. His temperature today is 103.6 degrees Fahrenheit, and his examination is significant for clear nasal discharge and multiple small vesicles on the anterior tonsillar pillars and posterior palate. His examination is otherwise normal. He is accompanied by his mother who seems to be very concerned. The patient has been feeding well and all his developmental milestones have been timely so far. A complete blood count is normal.  Which of the following is his most likely diagnosis?

12 month old male patient for rhinorrhea and poor appetite, temperature 103.6 F.

12 month old male patient for rhinorrhea and poor appetite, temperature 103.6 F.

A. Hand, foot, and mouth disease

B. Apthous stomatitis

C. Herpangina

D. Stevens-Johnson syndrome

E. Kawasaki disease

5 Responses

  1. Herpangina (C)

  2. Herpangina
    Since child still playing and not so toxic looking

  3. Herpangina (C)

    Diagnostic exclusions:
    HFMD – no foot or hand involvement – r/o HFMD (clinical diagnosis)
    Apthtous stomatitis – fever, rhinorhea – r/o Apthtous stomatitis
    Kawasaki disease – no bulbar conjunctivitis – r/o Kawasaki
    Steven Johnson’s Syndrome (SJS) – no keratoconjunctivitis, no skin findings – r/o Steven Johnson’s Syndrome.

    Side Facts:
    Herpangina occurs in HFMD. Herpangina results from a less aggressive strain of coxsackie virus. Both conditions are caused by coxsackie virus.

  4. B.

  5. C

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