Question

History: A 9-year-old girl presented with low-grade fever, sore throat, and malaise for two days. These symptoms developed 10 days after arriving at a summer camp operated by a religious group. Recently, she was noted to have a dry cough and difficulty breathing. Her parents then brought her to the emergency department. The family had emigrated from Ukraine one year before. The child's immunization status could not be determined. She had been otherwise healthy. Physical Examination: Temperature: 38.9°C Pulse: 140/minute Respirations: 45/minute Blood Pressure: 92/50 mmHg Physical Examination - The patient was in severe distress; respiratory stridor was present; exudative pharyngitis and bilateral cervical adenopathy ("bull neck") were noted. A yellowish, leathery, thick membrane extending to the uvula and soft palate was also seen (see Figure 1) Laboratory studies Hematocrit: 42% White Blood Cells: 18,400/µL Differential: 92% PMNs Platelets: 320,000/µL Serum Chemistries: BUN 30 mg/dL, creatinine 1.0 mg/dL, O2 saturation 84% Imaging Chest x-ray was normal.

          History:
A 9-year-old girl presented with low-grade fever, sore throat, and malaise for two days. These symptoms developed 10 days after arriving at a summer camp operated by a religious group. Recently, she was noted to have a dry cough and difficulty breathing. Her parents then brought her to the emergency department.
The family had emigrated from Ukraine one year before. The child's immunization status could not be determined. She had been otherwise healthy.

Physical Examination:
Temperature: 38.9°C
Pulse: 140/minute
Respirations: 45/minute
Blood Pressure: 92/50 mmHg
Physical Examination - The patient was in severe distress; respiratory stridor was present; exudative pharyngitis and bilateral cervical adenopathy ("bull neck") were noted. A yellowish, leathery, thick membrane extending to the uvula and soft palate was also seen (see Figure 1)

Laboratory studies
Hematocrit: 42%
White Blood Cells: 18,400/µL
Differential: 92% PMNs
Platelets: 320,000/µL
Serum Chemistries: BUN 30 mg/dL, creatinine 1.0 mg/dL, O2 saturation 84%

Imaging
Chest x-ray was normal.

History:
A 9-year-old girl presented with low-grade fever, sore throat, and malaise for two days. These symptoms developed 10 days after arriving at a summer camp operated by a religious group. Recently, she was noted to have a dry cough and difficulty breathing. Her parents then brought her to the emergency department.
The family had emigrated from Ukraine one year before. The child's immunization status could not be determined. She had been otherwise healthy.

Physical Examination:
Temperature: 38.9°C
Pulse: 140/minute
Respirations: 45/minute
Blood Pressure: 92/50 mmHg
Physical Examination - The patient was in severe distress; respiratory stridor was present; exudative pharyngitis and bilateral cervical adenopathy ("bull neck") were noted. A yellowish, leathery, thick membrane extending to the uvula and soft palate was also seen (see Figure 1)

Laboratory studies
Hematocrit: 42%
White Blood Cells: 18,400/µL
Differential: 92% PMNs
Platelets: 320,000/µL
Serum Chemistries: BUN 30 mg/dL, creatinine 1.0 mg/dL, O2 saturation 84%

Imaging
Chest x-ray was normal.

Added by Elizabeth S.

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