Ask The Results Of The Lab Check

Hello DocSy, I want to ask my 8-year-old child to have a blood check in the lab. The type of hematology examination turned out to be a low leukocyte count of 3,300 where the referral value was 4,000-10,000. Child’s illness was red rash, there was fever up and down for 5 days, there was like a red black wound around the lips. Is this characteristic of steven johnson virus or virus measles ?? Please explain doc. Thank you for your attention.

1 Answer:

Hi Ronald,


The results of examination of leukocytes (white blood cells) lower than normal (leukopenia) are found in many diseases caused by acute viral infections. There are so many types of viruses. For example, in patients with influenza (caused by influenza virus), dengue hemorrhagic fever (dengue virus), blood test results can be in the form of leukopenia.


Besides leukopenia can also be found in other conditions such as aplastic anemia, HIV infection, systemic lupus erythematosus, sepsis, tuberculosis, side effects of certain drugs.


Besides leukopenia, of course other blood results can be used as a guide for certain diseases, such as platelet values, hemoglobin, leukocyte count, and other tests.


In addition to complaints of fever, acute viral infections are often accompanied by an abnormality in the skin called viral exanthema. There are various forms of viral exanthema ranging from maculopapular, vesicular (fluid-filled bouncy), papular, etc. Viral exanthema with maculopapular erythema (such as a picture of red patches or reddish bumps that are palpable, palpable on the skin) can be found in the following diseases:


Measles (measles), the incidence has been greatly reduced due to measles vaccination which is included in the basic immunization (mandatory) in Indonesia. Complaints of fever precede 3-4 days, then a reddish rash on the skin, accompanied by itching. The typical rash appears first in the area behind the ear - the back hairline and then throughout the body. The initially reddish rash will darken and scaly skin, then disappear.
Fifth disease (parvovirus B19). More common in children than adults. The rash that accompanies the fever is especially visible in the area of ​​both cheeks. The rash can spread to the chest, back, buttocks, arms, lower legs.

Roseola (most often due to Herpesvirus 6). High fever suddenly for 3-4 days. When the fever goes down, the rash first appears on the chest - back, then only to the face, arms, lower legs.
Rubella (Togaviridae family virus). Fever is not high 2-5 days, then the rash appears with a typical spread from the new head - face area to the lower body.

There are many more viral infections with complaints of fever + rashes all over the body. It is difficult to determine the exact cause without seeing firsthand the appearance of a rash on the patient's body, as well as a complete history taking of the patient's symptoms. Diagnosing a disease cannot only be seen one at a time, for example leukopenia, fever alone, but need to be linked to each other. Direct physical examination is also very necessary to diagnose a skin rash.


Diseases caused by viral infections are self limiting diseases, meaning they can heal on their own because of the patient's immune system. Treatment is symptomatic, which aims to reduce the symptoms experienced by patients, such as reducing fever, reducing itching, relieving sore throat or complaints of headaches, etc. However, certainly, if caused by a viral infection, this disease is contagious. Usually the most infectious phase is during the initial phase of fever before the appearance of skin rashes.


The differential diagnosis of skin rashes other than due to a viral infection can also be caused by eruption (drug allergic reaction) and toxic shock syndrome (due to bacterial toxins).


Steven Johnson syndrome (SJS) is a form of skin and mucosal disorders that is very severe and very rare. The cause of SJS is difficult to determine, but in patients with SJS the most common cause is a reaction to certain drugs such as anti-gout (gout), anti-seizure drugs, pain relievers (ibuprofen, naproxen, etc.), antibiotics. SJS can also occur in cases of infection (less frequently), such as infections by the Herpes virus, HIV, hepatitis A.


SJS is characterized by:

Flu-like symptoms - fever, cough, runny nose, sore throat
Purplish red rash and resilience formation - blisters all over the skin and mucosa that are predominantly painful. The patient feels severe pain in the skin - such as burns.

SJS is a medical emergency. Patients with SJS need hospital care. You can compare images of rashes and skin lesions of SJS patients at these sites with the rash experienced by your child. If it resembles and complains accordingly, it is better to take the child immediately to the nearest health facility for further check-up and given appropriate treatment.


Even the current outbreak of Covid-19 (caused by the SARS-CoV-2 virus) in addition to providing the main symptoms of high fever and respiratory symptoms, in several case reports found patients with additional maculopapular rash that resembles measles. So patients must be more vigilant because this disease is very infectious (easily contagious).


Have you had the chance to bring your child to see a doctor? High fever + rash all over the body is a symptom that requires parents to take the child to see a doctor. Comply with prevention measures for Covid-19 transmission when bringing children to health facilities:

Use a mask
You don't need many people delivering
Do not take public transportation that is full of passengers
Physical distancing while waiting in the waiting room (if you can first contact the intended health facility, to ask the doctor's practice schedule or enter a queue number)
Wash your hands frequently with running water and soap
Do not allow children to touch objects in public places. Do not touch the face, especially the eyes, nose, mouth with hands that have not been washed.

If now your child's condition has been given therapy by a doctor, please continue the medication given. As long as there are no severe symptoms such as shortness of breath, severe headaches, seizures, loss of consciousness, treatment can be done at home. Give fever medication if fever still exists. Viral exanthema generally occurs when the fever has begun to subside. The course of the disease due to viral infection with viral exanthema varies from 5-7 days, 7-10 days, up to 10-14 days to heal. Isolate a sick child so as not to infect other healthy children. All family members at home must adopt clean and healthy living behaviors.


If there is a medical emergency, please immediately bring the child to the nearest emergency department.


Thus the explanation from me, hopefully useful.

: by

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