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.