a rejang river rash
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ID: 241614
2014
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Abstract
A 30-year-old Iban woman presented to a rural primary healthcare clinic located along the
Batang Rejang in Sarawak. She had a 2-day history of rash, which started over her trunk and
later spread to her face and limbs. What started out as individual erythematous maculopapular
spots later coalesced to form larger raised blotches. The rash was extremely pruritic and affected
her sleep, and hence her visit. The rash was preceded by high grade, persistent fever that was
temporarily relieved by paracetamol. She also complained of malaise, arthralgia and myalgia. Her
appetite had been poor since the onset of the fever.
She lived in a long house at the edge of the jungle. Although she did not have a history of going
into the jungle to forage, she went regularly to the river to wash clothes.
Clinically, she appeared lethargic and had bilateral conjunctival injection. Her left anterior
cervical lymph nodes were palpable. There were erythematous macules measuring 5 to 15
mm distributed over her whole body but predominantly over the chest and abdominal region
(Figure 1). An unusual skin lesion was discovered at the right hypochondriac region. This lesion
resembled a cigarette burn with a necrotic centre (Figure 2).
There was no evidence of hepato-splenomegaly. Examination of the other systems was
unremarkable. On further questioning, the patient admitted being bitten by a ‘kutu babi’ or
mite 3 days before the onset of her fever.
| Reference Key |
lim2014malaysiana
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|---|---|
| Authors | ;Jean-Li Lim |
| Journal | Pediatric research |
| Year | 2014 |
| DOI |
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| URL | |
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