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Comprehensive iHuman Case Study Week #4: 25-Year-Old Female with New Rash (Class 6512) 2025| Full Analysis Including HPI, Physical Exam, Differential Diagnosis, and Management Plan Case Instructions H&PeDx CASE PLAY SETUP AND INSTRUCTIONS |-Human Case Week moot na nit in Learning heads, Feedback eppears after submitting wach swction, o8 (160 on) 120.0 (D4.5 kp) Reason for encounter Now rash Case avthyrod by Lauren Pufact, Okie A CG 25 yo F “Thave this ugly looking rash on my upper thighs" HPI: The Patient is a 25 y/o female presenting with ar bilaterally on her inner thighs, and her left inner foreat about 36 hours ago after hiking in Napa with her boyfi spent time hiking, tried a new sunscreen, tried new foc anew drink, as well as spending time in the hot tub wi reports that her boyfriend does not have similar sympt ‘not tried any treatments for the rash. Jationshi Reproductive Hx Age of menarche: “doesn’t remember.” ‘Menstruation cycle duration: “seems fine to me.” Breast screening: Conducts self-breast exams Last Pap Smear: 1 year ago, with no signs of ‘ Lit ‘Allergies Ceclor (Cefaclor) second generation cephalosporin — List of Current Medications/supplements: Birth cor Supplements; None illnesses . No history of similar rashes . Recent Illnesses: . Sore throat 1 week ago > Treated with amoxicillin - Medications: . Amoxicillin (started 5 days ago) . Allergies: None known . Social History: .No recent travel . No illicit drug use .No new cosmetic products or detergents 2. Physical Examination Findings: General Appearance: Alert, well-nourished, no acute distress Vital Signs: . Temperature: 99.8°F (low-grade fever) . Heart Rate: 84 bpm (normal) . Blood Pressure: 118/76 mmHg (normal) . Respiratory Rate: 16 breaths/min (normal) Skin Examination: . Diffuse erythematous maculopapular rash - Non-blanching, mildly pruritic . No vesicles, pustules, or bullae - No Nikolsky’s sign (rules out severe skin conditions like SJS/TEN) HEENT: . Pharyngeal erythema, no exudates . No cervical lymphadenopathy Cardiovascular: 2. Viral Exanthem (EBV or Parvovirus B19) . 2. Viral Exanthem (EBV or Parvovirus B19) # Reasoning: - Maculopapular rash + low-grade fever + fatigue + recent sore throat suggest a viral illness . EBV (Infectious Mononucleosis) is a common cause of rash, especially if amoxicillin was given . Parvovirus B19 can also present with rash, joint pain, and fatigue . W Supporting Features: Recent sore throat without cough (suggests EBV over a typical viral pharyngitis) . Fatigue and mild joint pain (common in viral exanthems) - No conjunctivitis, Koplik spots, or photophobia (rules out measles) - No petechiae or purpura (rules out meningococcemia) ~ Differentiating Between EBV & Parvovirus B19: .Feature -EBV - Parvoviru (Mono) s B19 .Starts on .After ‘cill face, piece then .Rash Onset in use spreads . EBV . Parvoviru . Feature (Mono) s B19 Splenomegaly .Possible .No @# Tests to Confirm Diagnosis: Monospot Test or EBV Serology > Detects EBV infection CBC with Differential > Atypical lymphocytes suggest EBV Parvovirus B19 IgM/IgG > Confirms Parvovirus B19 ~W Management: lf EBV: Supportive care (rest, hydration, NSAIDs for pain) Avoid contact sports for 4 weeks (risk of splenic rupture) Expect prolonged fatigue If Parvovirus B19: Supportive care (hydration, NSAIDs for joint pain) Educate on self-limiting nature of the disease Would you like any further clarifications? History of recent sore throat suggests infectious mononucleosis (EBV) Rash is exacerbated by amoxicillin in EBV patients - Elevated eosinophils > Suggests drug reaction . Lymphocytosis (7S atypical lymphocytes) > Suggests viral cause (EBV) @ ¢RP/ESR > Elevated in inflammatory conditions 5. Management Plan: If Drug-Induced Rash (Likely Scenario) STOP Amoxicillin immediately Give Antihistamines (Diphenhydramine or Loratadine) for itching Monitor for Progression > Watch for severe reactions (SJS/TEN) If EBV (Mono) Is Confirmed Avoid Ampicillin/Amoxicillin (rash worsens in EBV patients) Supportive care: Rest, hydration, NSAIDs for fever/joint pain If Scarlet Fever (Strep Throat) Switch to Azithromycin or Cephalexin if confirmed Strep throat Symptomatic treatment (fluids, analgesics) 6. Follow-Up Recommendations: Follow up in 48 hours if symptoms worsen or rash spreads Educate patient on signs of severe allergic reactions (e.g., blistering, swelling, breathing difficulty) If viral, counsel patient on symptom management and avoid physical exertion (EBV- associated splenomegaly risk) 2. Physical Examination Findings: No Nikolsky’s sign (rules out StevensJohnson Syndrome/Toxic Epidermal Necrolysis) Rash predominantly on trunk, arms, and legs, sparing the palms and soles Head, Eyes, Ears, Nose, and Throat (HEENT): Mild pharyngeal erythema, no exudates No cervical lymphadenopathy No conjunctivitis or Koplik spots (rules out measles) Cardiovascular: Regular rate and rhythm, no murmurs, rubs, or gallops Respiratory: Clear breath sounds bilaterally, no wheezing, rales, or rhonchi Abdomen: Soft, non-tender, no hepatosplenomegaly (important if suspecting EBV) Musculoskeletal: Mild joint tenderness (especially small joints), no visible swelling or erythema Neurological: Alert and oriented x3 No focal neurological deficits 
