Nokea
A 28 y.o. patient without permanent residence was admitted to the hospital with the preliminary diagnosis influenza. On the fith day of illness he got a maculopapular petechial rash on his body and internal surfaces of extremities. Body temperature is 410 C, euphoria, face hyperemia, sclera reddening, tongue tremor, tachycardia, splenomegaly, excitement. What is the most probable diagnosis?
Correct Answer: A
Rationale: Step 1: Initial diagnosis of influenza suggests a viral illness.
Step 2: Presence of maculopapular petechial rash and high fever indicates a systemic infection.
Step 3: Symptoms like euphoria, hyperemia, tachycardia, splenomegaly, and excitement are characteristic of epidemic typhus.
Step 4: Face hyperemia, sclera reddening, and tongue tremor are specific to epidemic typhus.
Step 5: Epidemic typhus is transmitted by body lice, which fits the scenario of a patient without permanent residence.
Summary:
- Delirium alcoholicum is unlikely due to the specific symptoms and lack of history of alcohol abuse.
- Leptospirosis typically presents with jaundice and renal symptoms, not seen in this case.
- Measles rash is different from the maculopapular petechial rash described.