LAUSR

We present a case of a febrile 3-month-old infant with atypical acral swelling and erythema for 2 days’ duration. He was born full-term via normal vaginal delivery, with no maternal risk factors for sepsis. His parents sought medical attention in view of increasing lethargy and irritability. On physical examination, there was a blanching maculo-papular rash over the trunk and extremities with acral swelling (Figs 1–3). The infant was febrile (maximum temperature 39.8 C) with tachycardia that was out of proportion to fever spikes. His heart rate was in the range of 180–200 beats/min, which raised concerns for underlying sepsis. Intravenous ampicillin and gentamicin were administered immediately. His white cell count was 5.30 × 10/L (5–15 × 10/L; 48% neutrophils, 41% lymphocytes, 10% monocytes) and C-reactive protein level was unremarkable (6.3 mg/L). Blood, urine and cerebrospinal (CSF) cultures were negative. CSF did not reveal any pleocytosis (CSF WBC 0, CSF protein 0.26 g/L). In view of worsening acral erythema associated with swelling, there were concerns of evolving Kawasaki disease (KD). Blood tests were repeated on the third day of hospitalisation due to concerns of KD as child had persistent irritability and fever