Intended for healthcare professionals

Endgames Spot Diagnosis

A 5 year old girl with fever and rash

BMJ 2021; 372 doi: (Published 11 March 2021) Cite this as: BMJ 2021;372:n381
  1. Sung-Tse Li, paediatrician,
  2. Fu-Yuan Huang, paediatrician,
  3. Chien-Yu Lin, paediatrician
  1. Department of Paediatrics, Hsinchu MacKay Memorial Hospital, Hsinchu City, Taiwan
  1. Correspondence to: C-Y Lin mmhped.lin{at}

A 5 year old girl presented to her doctor in northern Taiwan with pyrexia for five days and a two day history of rash over her face, trunk, and limbs. Twelve days earlier she had returned from Indonesia, where she had spent time with her cousin who had similar symptoms.

Examination showed conjunctivitis, coryza, and widespread erythematous maculopapular exanthema on the face (fig 1), chest, abdomen, and limbs. Lesions resembling salt sprinkles were also present bilaterally on the buccal mucosa.

Fig 1

Bluish-white lesions on the buccal mucosa (black arrows), and diffuse red maculopapular lesions on the face (arrowheads)

The patient’s vaccinations were up to date according to the vaccination schedule in Taiwan, meaning that she had received one dose of the measles vaccine …

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