Author:  Tay Xue Chao Brian Diaz / Editor: Thomas MacMahon / Codes: HC5, HP1, HP2, SLO1, SLO5 / Published: 16/01/2020

A 3-year-old boy presents with a 3-day history of runny nose, cough, low grade fever, reduced oral intake and lethargy. 

His mother is worried that he’s been getting frequent infections over the last few weeks. She’s noticed that he hasn’t been eating properly while he’s been off form and has lost some weight. He has had infrequent nose bleeds. She’s been to her GP, GP out of hours service and your ED with him on several occasions, and has been prescribed multiple courses of antibiotics with a trial of inhalers.

On examination, the patient appears pale and lethargic – certainly not his “usual happy self” according to mum. His airway is patent, but he does exhibit mild respiratory distress. On auscultation, you hear a mix of scattered crackles, wheeze, and transmitted upper airway sounds. His throat and ears are clear, and he has no rash or photophobia. You also notice some bruising around his arms and lower legs.