Nightly Fever, Swollen Lymph Nodes, and Rash in a 3-Year-Old

Sarah Taber, MD

Disclosures

December 16, 2019

Editorial Collaboration

Medscape &

Editor's Note:
The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.

Background

A 3-year-old boy with no significant past medical history presented to the emergency department (ED) with 10 days of nightly fever. He also had cervical lymphadenopathy and an intermittent erythematous macular rash similar to the one shown below.

His parents also stated that he exhibited pain bilaterally in his knees, ankles, and hips. Before the onset of the fevers, he had been well. His parents reported no other symptoms, including conjunctivitis, oral mucosal changes, hand or foot swelling, rhinorrhea, cough, dyspnea, abdominal pain, vomiting, or diarrhea. He had no known sick contacts. His parents reported no travel outside the United States. The family has no pets. He has one older brother, who is healthy. The parents reported no relevant family history.

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