Author: Gabriel Haynes / Editor: Emily Rashleigh / Codes: IC4, SLO5 / Published: 30/01/2026
A 4-year-old boy, previously well, presents to the emergency department (ED) with a 6-day history of high fever, unresponsive to paracetamol. His parents report irritability, poor oral intake, and a spreading erythematous rash. He was reviewed by his GP three days ago and prescribed oral antibiotics for presumed tonsillitis, without improvement.
On examination, he is febrile at 39.5°C, tachycardic at 140 bpm, and irritable but alert. His lips are cracked and erythematous, his tongue has a “strawberry” appearance, and there is bilateral non-purulent conjunctival injection. A maculopapular rash is present over the trunk and limbs, with swelling of the hands and feet. Cervical lymphadenopathy is noted.
Initial bloods show elevated CRP (120 mg/L), ESR (60 mm/hr), and neutrophilia. A chest X-ray and urine dip are unremarkable. Sepsis is initially considered, and blood cultures are taken. The persistence of fever despite antibiotics raises concern for a systemic inflammatory syndrome.