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A 13-month-old girl was hospitalized with acute exudative tonsillitis. The product of a full-term normal delivery, she had had occasional mouth ulcers and recurrent tonsillitis treated with oral antibiotics by her family physician. Her vaccinations were all up to date including the measles, mumps, and rubella vaccine given 2 days before hospitalization, the day of fever onset.
Admission examination revealed severe exudative pharyngitis and oral candidiasis. Laboratory parameters included a hemoglobin level of 11.4 g/dL (to convert to grams per liter, multiply by 10), white blood cell count of 5600/μL (to convert to × 109 perliter, multiply by 0.001), absolute lymphocyte count of 5600/μL (to convert to × 109 perliter, multiply by 0.001), absolute neutrophil count of 300/μL (to convert to × 109 perliter, multiply by 0.001), platelet count of 327 × 103/μ (to convert to × 109 per liter, multiply by 1), and C-reactive protein level of 183 mg/L (normal range, <10mg/L; to convert to micromoles per liter, multiply by 9.524). Intravenous benzylpenicillin was initiated and was followed by defervescence and improvement in her condition. Admission blood and throat culture results were negative.
Flinn A, McDermott M, Butler KM. A Child With Septic Shock and Purpura. JAMA Pediatr. 2016;170(4):391-392. doi:10.1001/jamapediatrics.2015.2466