History of Present Illness
A 7-year-old boy with no underlying conditions is brought to the emergency department (ED) by his mother for fever, sore throat, abdominal and neck pain, and rash. These symptoms started 6 days ago. His mother took him to his pediatrician on illness day 4, where he had several palpable (< 1 cm) left-sided cervical lymph nodes and a macular rash on his torso on physical exam, and negative rapid streptococcal and rapid SARS-CoV-2 antigen tests performed. He was discharged home with supportive care for a likely viral syndrome. Two days later, on presentation to the ED, he was febrile to 103.1 °F and had left-sided neck pain, rash, abdominal pain, and new diarrhea. His mother noted that several children in his school were diagnosed with COVID-19 in the past month but is not sure whether he was exposed to them. He has not received any COVID-19 vaccines.
Emergency Department Course
In the ED the child is febrile to 101.5 °F, HR 110 (normal ranges [NR] for age per The Harriet Lane Handbook[1]: 60-100), RR 25 (NR 14-22), BP 110/65 (NR 100-120/60-75), SpO2 98% on room air, with exam notable for injected conjunctivae bilaterally without exudate; dry mucous membranes; pharyngeal erythema; several large left-sided cervical lymph nodes (largest > 1.5 cm in diameter) with moderate tenderness to palpation but no meningismus; an erythematous macular rash on his chest, abdomen, and back; and mild diffuse abdominal tenderness to palpation.
Public Information from the CDC and Medscape
Cite this: CDC Case Challenge: A Child With Fever, Neck Pain, Abdominal Pain, and Rash - Medscape - Dec 20, 2022.
