Review Question - QID 104246

This patient is presenting with a low-grade fever, cold-like symptoms, a characteristic rash (with macules and papules), and is well appearing suggesting a diagnosis of rubella.

Rubella is caused by the rubella virus (a togavirus) that is transmitted via respiratory droplets following an incubation period of 14-21 days. Prior to the appearance of the rash, patients typically experience the prodrome of malaise, mild conjunctivitis, low-grade fever, adenopathy, and cold symptoms. The rash begins on the face as pink macules. After 1 day, the rash typically spreads to the trunk and extremities. In contrast to measles, these patients are usually well appearing and have symptoms that begin to resolve around day 3.

Figure A is the rash with pink macules/papules that are commonly seen in rubella.

Incorrect Answers:
Answer 1: Kawasaki disease is characterized by "CRASH and burn" corresponding to symptoms of conjunctivitis, rash, adenopathy, strawberry tongue, and hand/foot desquamation with a fever.

Answer 2: Parvovirus can present with "slapped-cheek fever" in children, minor arthralgias in adults, and aplastic crisis in patients with hereditary spherocytosis/sickle cell anemia.

Answer 4: Rubeola or measles presents with a cough, conjunctivitis, coryza, and Koplik spots on the buccal mucosa. Usually, these patients have a high fever and become progressively more ill in contrast to rubella, where patients have mild symptoms and tend to improve around day 3.

Answer 5: Roseola is caused by human herpesvirus 6 and presents with a high fever (which can cause febrile seizures) followed by resolution of the fever then a maculopapular rash.

Bullet Summary:
Rubella presents with malaise, conjunctivitis, a low-grade fever, adenopathy, and a rash that begins on the face and spreads to the trunk and extremities.