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Case of the Month - October 2020

Kubheka S1, Birkett F1, Munian L1, Naidoo KL1, Banoo ZB1, Naidoo V1, Chinniah K1, Archary M1
1Department of Paediatrics and Child Health, University of KwaZulu-Natal

Case Presentation
A four-year-old male presented with a six-day history of fever and rash, followed by five days of loss of appetite, mouth sores and abdominal pain. He had diarrhoea for one day with no vomiting. His viral exanthem was managed at a hospital trauma outpatient unit but, as the fever was not settling, the child was taken to another hospital. The child lives with his paternal grandmother. Both his mother and aunt tested positive for SARS-CoV-2 a month before presentation and self-isolated without contact with the child. The child had not been to day-care since the national lockdown commenced. The child had no symptoms suggesting COVID-19 in the past month.

He looked ill and was irritable with a fever of 38.5°C although well perfused with regular saturation in room air. His tachycardia BP was normal on admission. He was puffy with oedematous hands and feet (Figure 1) with an erythematous maculopapular rash on the trunk and limbs (Figure 2) and non-tender cervical lymphadenopathy of one centimetre. Conjunctivitis and stomatitis were noted (Figure 3). His abdomen was tender over the right upper quadrant without peritonism and was distended with ascites. His cardiac and respiratory examination was normal with neurology without any meningism.

Figure 1
Figure 1. Pedal oedema
Figure 2
Figure 2. Erythematous maculopapular rash
Figure 2
Figure 3. Stomatitis and fissuring