Case History/Examination
A 5-year-old male resident of Kathmandu, Nepal presented to our center
with a history of fever and dark-colored urine. According to his mother,
the child had been apparently well and actively playful until the
previous day when he developed a sudden fever. The fever was
intermittent, maximum noted 101°F, and was not accompanied by chills or
rigors. The child had a headache, body ache, and passed dark colored
urine three times in the last 12 hours (Figure 1). The child denied
having any abdominal or back pain, or any urinary or gastrointestinal
symptoms. There was no history suggestive of upper respiratory tract
infection, mechanical trauma, porphyria, or bleeding diathesis. The
mother denied any recent consumption of beetroot, colored candies by her
child, or the introduction of new foods into his diet. There was no
significant travel or drug history. The child had no previous similar
episodes, and there was no significant family history.
At presentation, the child appeared lethargic with tachycardia (pulse
114 bpm, normal volume). He was afebrile, with a normal respiratory
rate, blood pressure of 90/50 mmHg (normal for his age, height and
gender), and oxygen saturation of 95% in room air. His Glasgow Coma
Scale (GCS) score was 15/ 15. Pallor and icterus were present, but there
was no limb or facial edema, signs of dehydration, or lymphadenopathy. A
thorough head-to-toe examination, including assessments of the central
nervous system, chest, and abdomen, showed no significant abnormalities.