Author: Kaushila Thilakasiri / Editor: Steve Corry-Bass, Nick Tilbury / Codes: ACCS LO 2, NeuC6, SLO5 / Published: 03/11/2022

A 12-year-old girl is brought to the Emergency Department (ED) by her parents with a 1-day history of headache, fever, vomiting and lethargy associated with a rash which has been rapidly developing over the last 3 hours.

The child’s mother says that they migrated to England from Sri Lanka 2 weeks ago.

She was previously well with normal development and has no siblings.

On initial assessment:

  • Airway – patent
  • Breathing – RR 25 breaths/min, SpO2 98% on air,
  • Circulation – Capillary Refill > 2 seconds, Pulse rate 114bpm, BP 100/60mmHg
  • Disability – GCS 12/15 E-3, V-4, M-5, Blood sugar- 5.4mmol/l, pupils equal reactive to light,
  • Exposure – temp 39C, generalised non-blanching purpuric rash. (see image). Mild-moderate dehydration is present, and you also note some neck stiffness.