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Question: Rash

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You are evaluating a 10 year old patient who had a bone marrow transplant 2 months ago. The patient is presenting with low-grade fever, a maculopapular rash on the nape of the neck, shoulders, palms, and soles as well as nausea, vomiting, and diarrhea. The patient owns a cat but is not involved in caring for it and does not have it sleep with him. 

Which of the following diagnoses are you most concerned about?

pemsou5_wp • March 21, 2023

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  1. Kelly March 24, 2023 - 12:16 pm Reply

    D) Acute graft vs. host disease
    Classic acute graft vs. host disease occurs within the first 100 days following allogenic bone marrow transplant, and is characterized by maculopapular rash, GI symptoms, and rising serum bilirubin. There may be fever. Toxoplasmosis can result from exposure to cat feces but is characterized by fever (sometimes FUO) and lymphadenopathy. The rash that can be seen in the second week of typhoid fever is “rose spots,” faint salmon-colored macules on the torso. The rash of Stevens-Johnson syndrome is classically targetoid, and rarely involves the palms and soles. Mucosal lesions are also characteristic.

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