HPI: 21 year old female with past medical history of glaucoma presents to the ED today for an allergic reaction. Patient has a rash all over her body and states the rash started 3 hours ago. She states she started Amoxicillin a week ago due to acute otitis media infection. She was given a course of Amoxicillin for 7 days, with today being her last day. She was at her PCP’s office later today and received a cortisone injection with Benadryl 30 mins prior to arrival and states she has a burning sensation but has since improved. States 2 years ago she presented with a rash that went away with Benadryl. Patient reports headache and feeling fatigued. Patient denies sore throat and does not present with a fever. She denies chills, nausea, vomiting,
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Alert, awake, and oriented x 3
Assessment
1. Infectious mononucleosis
2. Rash
Plan
1. Order CBC with differentials, liver function test, serum bilirubin, and Monospot test. Advised patient to rest, stay hydrated, and avoid contact sports or any trauma for at least 1 month. Discharged with Ibuprofen 800mg. Follow up with PCP.
2. Prednisone corticosteroid IM.
Discussion
• Results of monospot test were positive, elevated lymphocyte count and liver function test showed elevated serum transaminases. CBC with differentials showed elevated WBC count and elevated lymphocyte count. Elevated ESR was also noted.
• Patient with infectious mononucleosis that is given Amoxicillin will have an morbilliform rash all over body. Rash appears as red flat patches and usually appears 5-7 days after taking Amocillin and is typically found on the chest, back, and abdomen, and can spread to arms, legs and face. The rash can last up to 6 days.
• The most common mode of transmission is through exposure to infected saliva, often from kissing. But can also be spread through sexual transmission. Increased risk of Hodgkin’s lymphoma with patients with IM have been
Alert, awake, and oriented x 3
Assessment
1. Infectious mononucleosis
2. Rash
Plan
1. Order CBC with differentials, liver function test, serum bilirubin, and Monospot test. Advised patient to rest, stay hydrated, and avoid contact sports or any trauma for at least 1 month. Discharged with Ibuprofen 800mg. Follow up with PCP.
2. Prednisone corticosteroid IM.
Discussion
• Results of monospot test were positive, elevated lymphocyte count and liver function test showed elevated serum transaminases. CBC with differentials showed elevated WBC count and elevated lymphocyte count. Elevated ESR was also noted.
• Patient with infectious mononucleosis that is given Amoxicillin will have an morbilliform rash all over body. Rash appears as red flat patches and usually appears 5-7 days after taking Amocillin and is typically found on the chest, back, and abdomen, and can spread to arms, legs and face. The rash can last up to 6 days.
• The most common mode of transmission is through exposure to infected saliva, often from kissing. But can also be spread through sexual transmission. Increased risk of Hodgkin’s lymphoma with patients with IM have been