Image Based Case Discussion : 02/05/2026

General
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CLINICAL CASE DISCUSSION:

A 6-year-old boy is brought to the pediatric outpatient department with complaints of high-grade fever for the past 6 days. The parents report that the fever has been persistent and poorly responsive to antipyretics. Over the last 3 days, the child has become increasingly irritable and lethargic.

On further history, the mother noticed redness of both eyes without discharge, cracked lips, reduced oral intake, and a diffuse reddish rash over the trunk and extremities. There is no history of recent drug intake or known allergies.

On examination:

  • Temperature: 39.4°C
  • Pulse rate: 122/min
  • Bilateral non-purulent conjunctival congestion
  • Dry fissured lips
  • Enlarged unilateral cervical lymph node
  • Diffuse polymorphous erythematous rash

Oral cavity examination reveals a bright red tongue with prominent papillae giving a classic “strawberry tongue” appearance.

Histopathology image
Histopathology image830×547 74.5 KB

Symptoms
Symptoms985×680 118 KB

Questions for discussion

  1. What is the most likely diagnosis in this child?
  2. What are important differential diagnoses associated with strawberry tongue?
  3. Which serious cardiovascular complication should be ruled out early?
  4. Why is early recognition clinically important in pediatric practice?

Sometimes a simple oral examination can reveal a potentially life-threatening systemic disease before investigations even return."

MBH/AB

6 Likes
2

Most likely it is Kawasaki disease.

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4

Very informative and interesting pediatric case. :+1:

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  1. Kawasaki disease
  2. Scarlet fever and toxic shock syndrome
  3. Coronary artery aneurysm
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  1. It seems like a classical presentation of Kawasaki disease.

  2. The differential diagnosis I can think of is Scarlet fever.

  3. Coronary artery aneurysm is a cardiac condition that needs to be ruled out.

  4. I think early diagnosis is essential since it is associated with a cardiac condition that could be life-threatening if neglected.

7

The child most likely has Kawasaki disease, characterized by prolonged fever, conjunctivitis, strawberry tongue, cracked lips, rash, and cervical lymphadenopathy. Early diagnosis is important to prevent serious complications such as coronary artery aneurysms and other cardiac abnormalities.

8

Most likely diagnosis here is Kawasaki disease (mucocutaneous lymph node syndrome).