Author: Gabriel Haynes / Editor: Emily Rashleigh / Codes: / Published: 30/01/2026
A 4-year-old boy, previously well, presents to the emergency department (ED) with a 6-day history of high fever, unresponsive to paracetamol. His parents report irritability, poor oral intake, and a spreading erythematous rash. He was reviewed by his GP three days ago and prescribed oral antibiotics for presumed tonsillitis, without improvement.
On examination, he is febrile at 39.5 C, tachycardic at 140 bpm, and irritable but alert. His lips are cracked and erythematous, his tongue has a strawberry appearance, and there is bilateral non-purulent conjunctival injection. A maculopapular rash is present over the trunk and limbs, with swelling of the hands and feet. Cervical lymphadenopathy is noted.
Initial bloods show elevated CRP (120 mg/L), ESR (60 mm/hr), and neutrophilia. A chest X-ray and urine dip are unremarkable. Sepsis is initially considered, and blood cultures are taken. The persistence of fever despite antibiotics raises concern for a systemic inflammatory syndrome.
