Eschar: A Stepping Stone to Scrub Typhus

A 9-year-old girl with a 5-day history of fever and headache presented to our emergency department. She did not report rhinorrhea, cough, abdominal pain, vomiting, or diarrhea. Physical examination revealed bilateral neck lymphadenopathy and nonpruritic macular rashes over her trunk and arms (Figure  1; available at www.jpeds.com). A painless papule was located on the buttock and eschar was diagnosed (Figure 2). Blood tests showed thrombocytopenia and elevated liver function (platelet count: 62 000/µL; aspartate transaminase: 297 U/L; and alanine transaminase: 295 U/L).
Source: The Journal of Pediatrics - Category: Pediatrics Authors: Tags: Rediscovering the Physical Exam Source Type: research