CASE SCENARIO A 3-year-old boy was admitted to SUMC with a 6 day history of high grade

fever with temperatures ranging from 38.5-39.5 degrees celsius, and a 1 day history of
swelling of the hands and feet. Prior to admission, his parents noticed rashes on the
abdomen which is persistent and lips that were dry and cracking. This was also associated
with redness of the eyes, a swollen tongue, and non-pitting edema on his hands and feet.
His past medical history had been uneventful and his vaccinations were up-to-date. On
physical examination, the patient was irritable and difficult to console. He was febrile with a
temperature of 38.5 degrees celsius. He had dry, cracked lips with a swollen tongue, and
had a maculopapular rash in the abdomen. Cervical nodes were not palpable and bilateral
conjuctivitis without exudates was also noted. Vital signs of the patient were as follows:
temperature = 38.5 C, pulse rate = 87 bpm, respiratory rate = 22 cpm, blood pressure =
100/70 mmHg. Significant laboratory results were as follows (normal range is shown in
brackets): Decreased hemoglobin count, 9.1 g/dl (11.5-14.5 g/dl) and decreased hematocrit,
30% (34-40%). Decreased RBC, 3.1 M/cumm (3.9-5.3 M/cumm) and elevated WBC, 15.3
T/cumm (5.0-14.5 T/cumm). Elevated platelet count of 465 T/cumm (150-400 T/cumm). In
pursuit of the cause of her fever, further tests were done. ESR was elevated, 13 mm/hr (0-
10 mm/hr) and CRP level was also elevated, 2.2 mg/dL (<1.0 mg/dL).