A 2-year-old male (Weight: 11 kg; Length: 85 cm) presented with high fever of 6 days duration. Fever was intermittent, relieved by paracetamol but recurred every 4-6 hours. The child has been irritable for the last 4 days and has had diarrhea for the past 2 days. On day 6 of fever, the child’s mother noticed a skin rash. There is no history of vomiting, cold or cough. Past history and family history were non-contributory. The patient was treated with paracetamol. No antibiotic was administered.
On physical examination, the patient looked sick and was irritable. The child’s temperature was 102 degreesoF, pulse was 154/min, and the respiratory rate was 28 per min. CNS examination revealed mild neck stiffness; however, there were no other localizing signs. Examination of the neck revealed a single enlarged cervical lymph node on the right side that was not tender. In addition, examination of the eyes revealed nonpurulent conjunctivitis. Abdominal examination revealed mild gaseous distension. The liver and spleen were of normal size. There was no respiratory distress or signs of dehydration. Other systems were normal.