(BMJ)—A 6-yo girl presented w/ complaints of acute onset of fever 5 days back, followed by abdominal pain, vomiting, and a generalized rash 3 days later. Exam: vital signs stable. Generalized red, nonblanching rash, w/ patchy areas of normal skin. Labs: hct, 45%; platelets, 52×109/L. She remained afebrile throughout her hospital stay. Blood test confirmed the dx. What is it?
Measles
Scarlet fever
Hemolytic uremic syndrome
Dengue infection
Toxic shock syndrome
You are correct. Her dengue NS-1 antigen was positive. Dengue can sometimes cause a confluent erythematous or petechial rash that doesn’t blanch on pressure, w/ small areas of normal skin termed “isles of white in a sea of red.” These rashes appear during periods of defervescence and gradually fade in 1wk. They may be due to an immune response to the virus and are usually asymptomatic, w/ pruritus reported in a minority of pts. This pt improved, w/ resolution of abdominal pain and vomiting w/in 2 days of hospital admission, and she was discharged home after 4 days. Rash subsided w/in 3 days of d/c.

BMJ Case Reports CP 2020;13:e234154
By vgreene, 24 September, 2020
By vgreene, 24 September, 2020