A mother reports that her 3-month-old son is fussy and has had a runny nose and fever for the past 5 days. She also notes that the infant developed a red, raised rash initially on his face, which spread to his abdomen and extremities over the course of a day. The mother reports that her son is eating less and has been breathing rapidly. The boy was born full-term in the United States and has no past medical history. He has had 1 vaccination at his primary care physician, at 2 months of age. The family just returned from a trip to London a week ago, and there are no other sick contacts in the family. The infant’s vital signs are: heart rate, 175 beats/min; respiratory rate, 45 breaths/min; rectal temperature, 38.3oC (101oF); and oxygen saturation, 91% on room air. The physical examination findings demonstrate bilateral conjunctival injection with no purulent drainage, rhinorrhea, and slightly dry lips and oral mucosa. The infant has a blanching maculopapular exanthem to his face, trunk, extremities, palms, and soles. Upon auscultation, he has rales at both lung bases.
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