Skip to main content
The BMJ logoLink to The BMJ
. 2003 Sep 27;327(7417):720. doi: 10.1136/bmj.327.7417.720

A 2 year old child with rash and fever

Rita Sharma 1, Andrew Boon 2, Anthony Harnden 1
PMCID: PMC200806  PMID: 14512480

Last week (20 September, p 668) we described the case of a 2 year old girl with a maculopapular rash, fever, and dehydration. Her general practitioner thought she had a self limiting viral illness but encouraged her father to return with Elisabeth if her symptoms didn't resolve. To look at discussion of the case so far go to bmj.com

Elisabeth returned to nursery. Over the next two weeks she spiked intermittent fevers of up to 39°C (fig 1). Her appetite continued to be poor and she was sleeping more. Although bright and alert at times, she was not her usual self and sometimes became clingy and irritable. Seventeen days after her initial fever, the skin over Elisabeth's fingers and toes peeled (fig 2). Her mother, concerned at this point, contacted an anaesthetist colleague. Elisabeth was seen at her local hospital by a paediatrician.

Fig 1.

Fig 1

Elisabeth's temperature chart showing intermittent swinging fever

Fig 2.

Fig 2

Peripheral desquamation

Credit: JKI

The paediatrician noted Elisabeth was irritable. Her temperature was 37°C. She had no rash. Her tongue and eyes were normal and her throat mildly inflamed. She had bilateral palpable cervical lymph nodes. No evidence of peripheral desquamation was noted. There were no abnormalities detected on examination of her chest, cardiovascular system, or abdomen.

Chest radiography and a 12 lead electrocardiogram showed no abnormality. Her blood tests, including analyses for haemoglobin, lymphocytes, and platelets, gave normal results. Her white blood cell count was raised at 20.7×108/l with a neutrophil count of 13×108/l. Her C reactive protein concentration was also raised (13 mg/ml; reference < 5 mg/l).

Questions

  1. This doesn't look like a simple viral illness now. What do you think the diagnosis could be?

  2. How would you manage Elisabeth's illness now?

  3. What would you say to Elisabeth's parents?

Please respond through bmj.com

This is part 2 of a 3 part case report where we invite readers to take part in considering the diagnosis and management of a case using the rapid response feature on bmj.com. In three weeks' time we will report the outcome and summarise the responses

Competing interests: None declared.

We welcome contributions of interactive case reports. Cases should raise interesting clinical, investigative, diagnostic, and management issues but not be so rare that they appeal to only a minority of readers.

Full details of criteria are available at: bmj.com/cgi/content/full/3267/7389/564/DC1


Articles from BMJ : British Medical Journal are provided here courtesy of BMJ Publishing Group

RESOURCES