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A 16-year-old, previously healthy boy came to the hospital with a history of fever for several days, nonproductive cough, and coryza. On examination he appeared to be acutely ill; his temperature was 39.5°C, with a pulse of 120 and a respiratory rate of 18 breaths per minute. Physical examination showed intense conjunctivitis, a macular rash on the trunk, and Koplik's spots on the buccal mucosa opposite the second molars (arrow). The patient was treated with supportive care and recovered uneventfully without complications. Koplik's spots are evanescent white papules that are classically present on the buccal mucosa opposite the second molars early in the course of measles. They are often overlooked because of the presence of the rash and systemic toxicity, but they are pathognomonic. The characteristic rash begins on the forehead and, during the next 24 to 48 hours, rapidly extends to the face, the torso, and the extremities. The patient had not been vaccinated against measles.
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