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Abstract: A 16-year-old male student presented to the clinic with a fever and rash that had been present for 2 days, and an examination revealed enlarged lymph nodes behind the ear and in the neck and a congested pharynx. A routine blood test was performed, suggesting a viral infection. A repeat test for rubella virus antibody IgM was positive, confirming the diagnosis of viral fever due to rubella, which is a viral infection. The patient was recommended to be hospitalized in isolation for 5 days and given systematic medication. After treatment, the body temperature returned to normal and the rash basically subsided, and the patient was discharged from the hospital.
[Basic information] Male, 16 years old
Disease Type】Rubella, viral fever
Hospital】Liaoning Provincial People’s Hospital
Date of consultation】June 2019
Treatment plan】Medication (ganciclovir injection, busulfan anti-inflammatory oral solution, thin glucose peptide injection)
Treatment period】5 days of inpatient treatment, followed by outpatient review after 1 week
Treatment effect】The patient’s body temperature returned to normal, the rash basically disappeared, and he was discharged from the hospital.
I. Initial consultation
The patient came to the hospital accompanied by her parents and described herself as having a fever and rash for 2 days, with general malaise and sore throat followed by a rash. The rash was initially confined to the head and face, but later spread to the trunk and extremities, and was a red maculopapular rash with marked itching and loss of appetite.
Physical examination: congested pharynx, dense red maculopapular rash around the body, 1-2 enlarged lymph nodes palpable in the neck, good mobility. The routine blood and rubella antibody tests showed low white blood cell count, low absolute value of lymphocytes and high C-reactive protein, suggesting viral infection, but negative rubella antibody. Although the rubella antibody was negative, empirical analysis based on the symptomatic manifestations suggested the possibility of viral fever due to rubella, and hospitalization was recommended for isolation treatment because of its infectious nature.
II. Treatment
After admission, the patient was isolated and had a maximum body temperature of 37.9°C. The rubella virus antibody IgM was rechecked positive. The viral fever caused by rubella was clear, and antiviral + immunomodulatory treatment was then given, using ganciclovir injection as a static dose and busulfan anti-inflammatory oral solution as an antiviral; thin glucose peptide injection as a static dose to enhance the body’s immunity.
In addition to the necessary treatment, the patient was instructed to pay attention to a light diet and bed rest during the treatment period. In addition, when the liver and kidney function and blood lipid tests were completed, the patient was found to have high blood lipid level and was advised to have a low-fat diet on weekdays.
III. Treatment effect
The patient was admitted to the hospital with fever, a large peripheral rash with obvious itching, and poor appetite. After one day of active treatment, the body temperature dropped to normal, the color of the rash gradually became lighter, fatigue and sore throat improved, and appetite increased. After 5 days of hospitalization, the patient’s rash basically subsided and there was no other spontaneous discomfort, and the routine blood tests were basically normal. The patient was asked to come back to the hospital one week later. At the time of the follow-up, the patient’s body temperature had returned to normal and the rash had basically subsided, so the treatment effect was good.
IV. Precautions
After 1 week of isolation and active care, the patient’s rash basically subsided and he no longer had fever and itching, which made him feel happy as the attending physician. However, it is still necessary to remind the patient that after discharge home, he should pay attention to control the diet at daily time, recommend low-fat, low-sugar and low-salt diet, and increase exercise appropriately. Since the patient’s appetite has just been restored, it is recommended to eat a light diet, not to eat too spicy and stimulating food, not to study under too much pressure, pay attention to the combination of work and rest, and avoid staying up late.
V. Personal insight
Although rubella is not as prevalent as measles and chickenpox, it is also highly contagious and can have various complications, especially congenital rubella syndrome (CRS). Rubella mainly infects children and adolescents, so if your child develops a fever as well as a rash, do not just self-medicate, but be alert for viral fever due to rubella and seek medical attention promptly. Rubella can be prevented by MMR triple vaccination, which is recommended for children.