A 3-year-old boy presented with abdominal pain, vomiting, lethargy and skin rash. The patient was in good health until nine days before admission. He developed vomiting and lethargy, which resolved spontaneously after three days. Five days before admission, he again became lethargic, appeared glassy-eyed, and was admitted to an outside hospital. Intravenous fluids and supportive care were administered for two days for a presumed diagnosis of gastroenteritis. At the time of his discharge, his family noted bilateral foot swelling with pain on ambulation.
One day before this admission, a rash on his lower extremities was noted. During the night, the patient began complaining of abdominal pain and started vomiting brown material. His rash was noted to have spread to his arms. He was admitted to the hospital. Medical History Six weeks before this admission, he had had Streptococcal…
