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. 2024 May;8(2):179-181.
doi: 10.5811/cpcem.1911.

Rash and Fever in a Returned Traveler

Helena Kons  1 , Elliott D Herron  1 , Zachary S Pacheco  1 , Erin F Shufflebarger  1
Affiliations

Rash and Fever in a Returned Traveler

Helena Kons et al. Clin Pract Cases Emerg Med. 2024 May.

Abstract

Case presentation: A 21-year-old, otherwise healthy female presented to the emergency department with fever among other nonspecific symptoms after recently returning from Ghana. On physical exam, she had a characteristic upper extremity rash, and a tourniquet test revealed numerous petechiae. The diagnosis of dengue was suspected and subsequently confirmed.

Discussion: Dengue is one of many viral illnesses that should be considered in returning travelers presenting with fever and other nonspecific symptoms. Emergency physicians must keep a broad differential when evaluating fever in returned travelers and prioritize history and physical exam findings to help narrow the diagnosis and provide appropriate management and supportive care while awaiting further confirmatory testing.

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Conflict of interest statement

Conflicts of Interest: By the CPC-EM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. The authors disclosed none.

Figures

Image 1.
Image 1.
Rash on upper extremity with characteristic confluent erythema and small areas of spared skin (arrow).
Image 2.
Image 2.
Appreciable petechiae visible in the antecubital fossa after inflating a blood pressure cuff around the upper arm for five minutes at a pressure halfway between the patient’s systolic and diastolic blood pressure. This “tourniquet test” is deemed positive if more than 10 petechiae are present within a square inch of skin, suggesting capillary fragility.
See this image and copyright information in PMC

References

    1. Grande AJ, Reid H, Thomas E, et al. . Tourniquet test for dengue diagnosis: systematic review and meta-analysis of diagnostic test accuracy. PLoS Negl Trop Dis. 2016;10(8):e0004888. - PMC - PubMed
    1. World Health Organization . Dengue and severe dengue. 2023. Available at: https://www.who.int/en/news-room/fact-sheets/detail/dengue-and-severe-de.... Accessed September 29, 2023.
    1. Centers for Disease Control and Prevention . Dengue: historic data (2010–2022). 2022. Available at: https://www.cdc.gov/dengue/statistics-maps/2020.html. Accessed August 1, 2023.
    1. Thwaites GE, Day N. Approach to fever in the returning traveler. N Engl J Med. 2017;376(6):548–60. - PubMed
    1. Yow KS, Aik J, Tan EY, et al. . Rapid diagnostic tests for the detection of recent dengue infections: an evaluation of six kits on clinical specimens. PLoS One. 2021;16(4):e0249602. - PMC - PubMed