1st April 2022

A 4-year-old girl attends the GP surgery with her mother

A 4-year-old girl attends the GP surgery with her mother. Over the last three weeks, her mother has noticed that she’s become more and more tired, has been eating less and losing weight. She gets short of breath more easily these days. At first, her mother thought she had a cold as she could feel the lymph nodes in her neck, but now a rash has come up in the last couple of days that doesn’t go away with “the glass test”. On examination, she is alert but quietly sat in her chair, she has a petechial rash all over her lower limbs and palpable, painless lymph nodes in her neck and groin. You also note hepatosplenomegaly, but she has no fever, neck stiffness or joint pains.

What is the most likely diagnosis?

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