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A young girl with fever and atypical rash
  1. Ellen Hoornaert1,
  2. Jean Cyr Yombi1,
  3. Halil Yildiz2
  1. 1 Cliniques Universitaires Saint-Luc, Bruxelles, Belgium
  2. 2 Internal Medicine, Saint luc University Hospital, Brussels, Belgium
  1. Correspondence to Dr Ellen Hoornaert, Cliniques universitaires Saint-Luc, Bruxelles 1200, Belgium; ellen.hoornaert{at}

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Clinical Introduction

A 17-year-old girl presented with a painful submandibular lymph node for 7 days, fever (up to 40°C) and asthenia for 5 days. She had no medical history and was not taking any medication. Vital signs were blood pressure 95/68 mm Hg, pulse 118 bpm, oxygen saturation 96% on room air. Physical examination showed a submandibular lymph node, bilateral conjunctivitis, palmoplantar erythrosis (figures 1 and 2) as well as a strawberry tongue (figure 3). Labs showed C-reactive protein at 338.7 mg/dL and white cell count at 11 720/µL (90% neutrophils). ECG demonstrated sinus tachycardia. Chest X-ray was normal and SARS-CoV-2 nasopharyngeal swab PCR was negative.

Figure 1

Palmoplantar erythrosis.

Figure 2

Palmoplantar erythrosis.

Figure 3

Strawberry tongue.


What is the most likely diagnosis?

  1. Kawasaki disease

  2. Scarlet fever

  3. Multisystem inflammatory …

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  • Contributors Every author contributed equally to this paper.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting or dissemination plans of this research.

  • Provenance and peer review Not commissioned; internally peer reviewed.