BMJ Case Reports 2018; doi:10.1136/bcr-2017-223497
  • Reminder of important clinical lesson

Teenage boy with high fever and rash: what could we be missing?

  1. Leonor Carvalho2
  1. 1Department of Paediatrics, Hospital Pediátrico de Coimbra, Coimbra, Portugal
  2. 2Paediatric Intensive Care Unit, Hospital Pediátrico de Coimbra, Coimbra, Portugal
  1. Correspondence to Dr Gracinda Nogueira Oliveira, gracenoliveira{at}
  • Accepted 25 January 2018
  • Published 8 February 2018


A 15-year-old boy was admitted to a local hospital with high fever, generalised rash and a mild sore throat. He was started on intravenous flucloxacillin and 12 hours later develops a sustained low diastolic blood pressure (DBP), unresponsive to fluid volume expansion and cardiovascular support with dopamine. Intravenous clindamycin was added and transportation to paediatric intensive care unit arranged. Dopamine dosing was increased and norepinephrine infusion was added subsequently with immediate stabilisation of DBP. A sacrococcygeal pilonidal abscess was identified, requiring prompt surgical drainage. The microbiological culture of abscess material was positive for an enterotoxin-producing Staphylococcus aureus and Peptostreptococcus magnus. He was free of symptoms after 4 days. This case report summarises a potential severe complication of the pilonidal disease.


  • Contributors GNO did the writing of this manuscript supported by substantial contributions from SC, FDC, TD and LC to conception and design, data collection, drafting, data interpretation, critical revision for important intellectual content and final approval. All authors were also involved in the initial assessment, management and follow-up of this patient.

  • Competing interests None declared.

  • Patient consent Guardian consent obtained.

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

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