Febrile Morbilliform Rash as a Clinical Presentation of COVI
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A 16-month-old male presented with a three-day history of high fever and rash with irritability. He was fully immunized and was previously healthy. The parents reported sudden and simultaneous onset of both fever and rash. His fever was high, reaching a maximum of 39 °C, recurred intermittently over the course of 3 days, and was responsive to antipyretics. The rash was diffusely pinkish to red and pruritic and progressed in a cephalocaudal direction; it involved the face only on the first day, followed by the neck, trunk and extremities over the course of the 2 days to follow.

Alongside with it, a honeycolored and crusty lesion on an erythematous base measuring 1 × 1 cm, in consistence with impetigo, was evidently present on the lower back. Apartfrom the fever and rash, he was mildly dehydrated otherwise active and able to take food and water orally.

The child lives with his family which consists of six members, of whom none developed any symptoms. His diet consists of milk supplemented by soft foods, and no new food was introduced recently to his diet.

Based on the COVID-19 screening scoring system provided by the Ministry of Health, nasopharyngeal swab for SARS-CoV-2 (RT-PCR) test was performed. Intravenous fluids were administered to treat acute dehydration and he was discharged to home with oral antipyretics, oral antihistamines and local antibiotics to be used to treat impetigo that had developed on the skin of his back.

The family was instructed to return to the hospital after 48 h for a followup assessment and to review the results of the nasopharyngeal swab test. The exanthematous rash remained, although the lesions on his back had healed. The result of the nasopharyngeal swab test was positive for SARS-CoV-2; the child was transferred with his mother to quarantine.

Upon following this patient up, the parents reported that his fever and irritability have improved within 72 h of their onset, followed by a gradual improvement of the rash over 5 days after the resolution of fever.

Source: https://theijcp.org/index.php/ijcp/article/view/408/352
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