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A 2 year old previously well girl presents to the emergency department with a 6 day history of  fever up to 39.7oC. The child has been fully immunized. The child has some decrease in appetite but is drinking well. History of mild rhinorrhea for 3 days. No sick contacts or recent travel. On examination, the child appears irritable and alert.  On head and neck exam, bilateral conjunctival injection is noted; tympanic membranes are normal; lips and tongue appear erythematous; and there is a 2cm soft mobile non-tender cervcial lymph node on the left.  There was no evidence of nuchal rigidity. Heart sounds were normal with no murmur appreciated. Peripheral pulses were normal.  Chest exam was clear. Abdominal exam was unremarkable. A diffuse maculopapular rash was noted on the trunk with swelling of hands and feet. Laboratory studies are as follows:  

CBC: 

WBC: 8

  • Absolute Neutrophil Count: 4

Hemoglobin 120

Platelets 498

Urinalysis:

WBC / HPF: 0

The most likely diagnosis for this child is:

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Authors

Dr. Angela Punnett

angela.punnett@sickkids.ca

Reviewers

Dr. Susan Bannister

Susan.Bannister@ahs.ca

Dr. Hosanna Au