A 3-year-old girl presented to urgent care with a 9-day history of fever, mouth sores, and a single red lesion on the right side of her face. She had been diagnosed with hand, foot, and mouth disease by her primary care provider a few days earlier. Because of persistence of fevers (99- to 103-degrees Fahrenheit), decreased energy levels, vomiting, and dark urine, she was taken to urgent care. She had no significant past medical history, no recent travel, and no concerning family history. She had no diarrhea.

In urgent care, she was tachycardic (148 bpm) and was noted to be jaundiced with scattered petechiae on her soft palate and delayed capillary refill. The laboratory work obtained was notable for the following:

• WBC: 20.45 × 103/mcl
• Hemoglobin: 3.7 g/dl
• Hematocrit: 12.9%
• Platelets: 7 × 103/mcl
• MCV: 103.2 fl
• Total bilirubin: 2.6 mg/dl
• Indirect bilirubin: 1.6 mg/dl

She was transferred to the pediatric intensive care unit. On examination, she was pale and jaundiced; had petechiae on her bilateral arms; had tachycardia with a slight flow murmur; had shoddy lymph nodes in bilateral inguinal, axillary, and cervical regions; and had no hepatosplenomegaly.

Which of the following would be the next best step?

Take the quiz.

Sana Farooki, MD
Karen Lewing, MD
Shannon Carpenter, MD MS
Children’s Mercy Kansas City

Details

Categories: Case Quiz