An 18-month-old boy was initially admitted to another hospital because of fever up to 39.9°C lasting for five days, a mild cough, one to two vomits and two to three yellowish diarrhoeas per day. On examination, apart from fever (38.8°C) no other pathological findings were present. Laboratory evaluation revealed leucocytosis (26,500/μl) with 47% neutrophils and an elevated erythrocyte sedimentation rate (ESR) (57 mm/1st hour) and C-reactive protein (CRP) (100 mg/l)
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Tests for infections were negative except for the detection of a rotavirus antigen (immuno-chromatographic test). The cultures from skin lesions were negative. On day one of hospitalisation, a papulonodular rash with lesions of up to 2 cm in diameter, some of them with central ulceration, appeared on the trunk and extremities. The child remained febrile, and in the following days, new crops of similar skin lesions erupted, while blood neutrophilia and elevated ESR and CRP persisted. On day six, a restriction of the spontaneous movements of the left hip, indicative of underlying arthritis, was added to his clinical picture, however, without corresponding pathological findings in X-ray and ultrasound imaging.
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