The child with a delayed triad after an antibiotic — structured encounter

Setting and candidate instructions

You are the paediatric registrar in the emergency department. A four-year-old boy is brought by his parents with a four-day history of a blotchy, moving rash over his trunk and limbs, low-grade fever and stiff, swollen knees. He finished a five-day course of cefaclor for an ear infection eight days ago. He looks miserable but not toxic, with normal observations, no mucosal involvement and no breathing difficulty. The examiner will ask you to build the diagnosis, exclude the dangerous mimics, choose and justify the investigations, construct the stepwise management plan, and make a defensible avoidance decision.