A mother brings her 5 year old son in for evaluation of fever and rash which have persisted over the past 6 days despite acetaminophen and ibuprofen. He has had a mild cough without shortness of breath. He complains only of a sore throat and left ear pain. He had one day of vomiting and diarrhea which had self resolved 48 hours ago. Since that time he has had very little oral intake. Has has no significant PMHx. FTVD. All immunizations are up to date. No other recent illnesses, known sick contacts or recent travel.
Temp: 102.8 °F (39.3°C), HR: 122, RR: 24, BP: 92/58, Sat.99%
He is alert and acting normally per mother.
As you perform a more thorough ENT exam, the child appears to have a moderate conjunctival and scleral injection without discharge and a left otitis media. He also appears to have significant left sided cervical and tonsillar LAD and bilateral tonsillar erythema without exudate.
His lips and oral mucous membranes are quite dry with diffuse erythema.
His lungs are CTA B/L, normal heart exam without murmur. Abdominal exam is benign. You also notice a peeling, slightly erythematous rash to the hands and feet.
1. What should be high on your differential list?
2. What complications might you be concerned about?
3. What is the treatment?
4. What is the prognosis?