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imnotarobotbut
Also, VZV causes pneumonia (what this patient probably had) and encephalopathy in the immunocompromised.
+9
nwinkelmann
What threw me off was that it didn't mention the synchronicity of the rash. I stupidly took failure to mention to mean that the rash was synchronous, which doesn't fit VZV because chickenpox rash is characterized as a dyssynchronous rash (i.e. all stages of the macule to papule to vesicle to ulceration are seen at the same time). MUST REMEMBER: don't add information not given!
+6
jboud86
If anyone wants to refresh info on Vaicella-Zoster virus, page 165 in FA 2019.
+2
an1
@imnotarobotbut measles also causes pneumonia (acc to sketchy micro)
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elephantbuddy
I was stuck on that too, but I think that measles more commonly presents with a maculopapular rash whereas a vesicular rash is more typical of VZV.
+3
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jrod77
I believe it's the vesicular rash that gives it away. I thought it was influenza too, but i re-read the questions and I realized they included a rash which disqualifies influenza.
+4
charcot_bouchard
Also h/o of immunsupression, disseminated VZV. Influenza itself doesnt cause severe disease. secondary PNA does. which u will see in elderly. usually
+1
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submitted by โsajaqua1(607)
Critical points for this question: 5 year old boy, immunosuppressed because of chemotherapy, 2 day history of fever, cough, shortness of breath, febrile (101.8 F), respirations 46/min, with cyanosis and generalized vesicular rash. Extensive nodular infiltration.
Of the options listed only measles and VZV give a rash. A rash from measles usually starts rostrally and descends caudally, and is flat and erythematous. By contrast, VZV (chickenpox) presents with generalized rash that quickly transitions from macular to papular then to vesicular.