Clinical Case 2

Farrah Nasrollahi, M.D.

Resident HPI

Chief Complaint: cough and rash

9 year old male with no significant medical hx presenting to ED due to cough of 1 days time + oral rash of 1 days time. Mother has  not documented any fevers at home but reports cold like symptoms. Denies sick contacts besides siblings with diarrhea. Patient has taken OTC cough medication (dayquil, robutussion PRN) which has not helped with cough and cold symptoms. Denies nausea, vomiting, diarrhea, constipation, hematuria, back pain. Reports minor dysuria. Denies headache , lightheadedness, dizziness, rashes or changes in color to the extremities, hands, soles, torso or face. Mother has noted redness of the eye and rhinorrhea. Patient is UTD on vaccinations and has not had any recent travel or recent infections with abx treatment. Patient has no known allergies. Family hx is noncontributory. No previous surgeries.

Attending HPI

9 yo M with nosig pmh here for wheezing, fever, cough, oral lesions. Oral lesions started today. Decreased po today. +pain with urination. no rash on hands or feet. No history of wheezing in the past. No new meds except dayquil and robitussin. No recent travel or new exposures. No notable PMH, PSH, no known family hx of asthma. Immunizations UTD.

Vital Signs

Temp(F/C) 102.4/39.1 → repeat 99.3/37.4

BP   105/69

Pulse 128

RR 26

SPO2 96 on RA

Weight 28.9 kg

Resident Physical Exam

Gen: WDWN, in NAD

Skin:  Warm, dry.  negative rashes to palms, soles, limbs, torso, face

Head:  Normocephalic, atraumatic.  

Neck:  Supple, no tenderness.  negative lymphadenopathy

Eye:  Extraocular movements are intact, normal conjunctiva.  +injection, - discharge

Ears, nose, mouth and throat:  Oral mucosa moist, no pharyngeal erythema or exudate.  + swollen lips, - uvular deviation, - petechia, - purulence, - tonsillar swelling +lip lesion

Cardiovascular:  tachycardia, regular rhythm, No murmur 

Arterial pulses: Bilateral radial  2+

Capillary refill: Bilateral upper extremity < 2 seconds.  

Respiratory:  Lungs are clear to auscultation, respirations are non-labored, breath sounds are equal.  inspiratory wheezes bilaterally to multiple lobes

Gastrointestinal:  Soft, No tenderness to palpation, Non distended   

Back: No midline Tenderness, no bony stepoffs

Musculoskeletal:  No tenderness, no swelling, no deformity.  

Neurological:  Alert and oriented to person, place, time, and situation, normal speech observed, No Facial Droop.  

Psychiatric:  Cooperative, appropriate mood & affect, normal judgment. 





Right lower lung zone patchy opacity which can represent pneumonia in the appropriate clinical


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Mycoplasma Pneumonia with MIRM

Classic MIRM is characterized by severe mucositis and variable, but generally sparse, cutaneous lesions. Most patients experience a prodrome of cough, malaise, and fever for approximately one week prior to the onset of their mucocutaneous eruption [1)

Urogenital lesions occur in approximately 60 percent of patients and can affect the vulva, vagina, any part of the penis (including the urethral meatus), and scrotum (1)

Ophthalmology Consult

** Of note, herpetic keratitis, typically a result of reactivation of latent disease, may re-occur in 25-50% of patients within 2 years and will require close follow up.

Dermatology Consult

Infectious Disease Consult

Presentation & Diagnosis






Hospital Course