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Differential Diagnosis for the 20-year-old College Student

Single Most Likely Diagnosis

  • Measles: The symptoms described, including high fever, cough, runny nose, conjunctivitis, followed by a red maculopapular rash that starts on the hairline and spreads down, are classic for measles. The fact that another student had similar symptoms 10 days prior supports a highly contagious etiology like measles.

Other Likely Diagnoses

  • Rubella (German Measles): Although less common due to vaccination, rubella can present similarly to measles with fever, rash, and conjunctivitis. However, the rash in rubella tends to be less severe and the fever lower.
  • Infectious Mononucleosis: Caused by Epstein-Barr virus, it can present with fever, sore throat, and rash, especially if the patient is taking ampicillin. However, the absence of sore throat and lymphadenopathy makes this less likely.
  • Adenovirus Infection: Adenoviruses can cause a range of symptoms including fever, cough, runny nose, conjunctivitis, and rash. However, the specific progression and characteristics of the rash are less typical for adenovirus.

Do Not Miss Diagnoses

  • Meningococcemia: Although the rash in meningococcemia is typically petechial or purpuric, not maculopapular, this condition is life-threatening and can present with fever and rash. It's crucial to consider this diagnosis due to its high mortality rate if not promptly treated.
  • Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis: These are severe skin and mucous membrane disorders usually caused by medications or infections. While the presentation can be with fever and rash, the context (e.g., recent medication use) and the nature of the rash (more severe with blistering) would differ.

Rare Diagnoses

  • Erythema Infectiosum (Fifth Disease): Caused by parvovirus B19, it can present with a "slapped cheek" appearance followed by a maculopapular rash on the body. However, the initial symptoms of fever, cough, and conjunctivitis are not typical for fifth disease.
  • Scarlet Fever: Characterized by a sandpapery rash that follows a sore throat and fever, scarlet fever is caused by group A beta-hemolytic streptococci. The absence of a sore throat makes this diagnosis less likely.

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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