Endgames Case Report

Persistent fever and rash in a young child

BMJ 2011; 343 doi: http://dx.doi.org/10.1136/bmj.d5196 (Published 19 September 2011) Cite this as: BMJ 2011;343:d5196
  1. Peter J Gill, medical student12,
  2. David Burgner, paediatric infectious diseases physician3,
  3. Anthony Harnden, university lecturer in general practice2
  1. 1Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
  2. 2Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
  3. 3Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, Australia
  1. Correspondence to: Peter J Gill peter.gill{at}phc.ox.ac.uk

A 22 month old white Australian boy presented to his general practitioner with irritability, red eyes, and a two day history of high fever (highest at 41°C) that did not respond to paracetamol and ibuprofen. He had no history of cough, coryza, or rash. His medical history was unremarkable and immunisations were up to date. On examination, he had bilateral non-exudative conjunctival injection and was diagnosed with a non-specific febrile illness with associated conjunctivitis. His family then took him on a planned family holiday to Thailand where his conjunctivitis improved, but the fevers continued unabated. In addition to the fevers, his parents noted a mild nappy rash. On day 8 of the illness, his parents took him to a local clinic after a couple of episodes of diarrhoea. He was diagnosed with gastroenteritis. Later that day he became more unwell with increasing irritability and a progressive rash so his parents took him to hospital. He was dehydrated and lethargic and physical examination showed cervical lymphadenopathy, fissured lips, and an injected pharynx. His hands and feet were oedematous and his legs were covered in a pink maculopapular rash. Blood tests showed leucocytosis and increased acute phase reactants, but other haematological markers were normal. A chest radiograph was normal. He was admitted with presumed bacterial sepsis and started on broad spectrum intravenous antibiotics. However, after two days of antibiotics, his symptoms did not improve.

Questions

  • 1 What is the most likely diagnosis in this case?

  • 2 How is this condition diagnosed and what further investigations are needed for a definitive diagnosis?

  • 3 What is the treatment for this condition?

  • 4 What are the cardiovascular complications of this condition?

Answers

1 What is the most likely diagnosis in this case?

Short answer

Kawasaki disease.

Long answer

The most likely diagnosis is Kawasaki disease. Differential diagnoses to be considered in a child with a history of …

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