Author: Fred Smith / Editor: Jessie Lynch / Codes: / Published: 06/08/2025
A 3-year-old boy presents to the Emergency Department (ED) with fever. His mum tells you that he has had fever for 6 days. They went to the GP a few days ago and were told he likely had a viral upper respiratory tract infection as he had a rash on his torso and some raised lymph nodes in his neck. However, mum is concerned that he may be dehydrated as his lips look red and cracked and he is a bit more irritable and upset than he was previously.
On examination
- Oxygen saturations 98% on air
- Respiratory rate 18
- Heart rate 150
- Blood pressure 100/70
- Temperature 39
His chest is clear on auscultation.
The childs heart sounds are normal. His central capillary refill time is 2 seconds. When you look at his hands you notice they are red and hyperaemic.
His abdomen is soft and non-tender with no organomegaly.
He has no nuchal rigidity but seems irritable.
When examining his throat, you notice erythematous, cracked lips. There is no exudate on his tonsils. He has a 2cm lymph node in his right anterior triangle.
He has a diffuse maculopapular rash over his trunk and his conjunctiva look red but there is no exudate.
