Clinical Review Interactive case report

A 2 year old child with rash and fever

BMJ 2003; 327 doi: (Published 18 September 2003) Cite this as: BMJ 2003;327:668
  1. Rita Sharma, clinical lecturer1,
  2. Andrew Boon, consultant paediatrician2,
  3. Anthony Harnden, university lecturer (
  1. 1Department of Primary Health Care, Institute of Health Sciences, Oxford OX3 7LF
  2. 2Royal Berkshire Hospital, Reading RG1 5AN
  1. Correspondence to: A Harnden

    Elisabeth first became unwell during the evening of her 2nd birthday. Her parents noticed that she was “grizzly and off her food.” Later that night she woke with a temperature of 38.9°C. During the next two days her fever, lethargy, and irritability persisted despite regular paracetamol. Her fluid intake was poor. On the second evening her mother noticed that Elisabeth was very thirsty but cried whenever she put a cup to her mouth. Her tongue was brick red, furrowed, dry, …

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