Some more on History and physical findings should have been available.Forexample,is the malnutrition
recent or chronic? Height could have helped.
Any way let us consider the D/D.
a.Kawasaki disease.
Persistent fever,lymphadenopathy, skin rash are usual features of KD;dysphagia may be due to enlarged mediastinal lymph nodes but purulent eye discharge and skin itch are difficult to explain.
b.Lymphoreticular malignancy.
Persistent fever,wt loss,gen.lymphadenopathy,dysphagia(mediastinal lymphnode compression)are explainable but again purulent eye discharge and skin itch can't be explained well.
c.Leukemias.
May present with all of these features but skin rash,skin itch and eye infection are less common mode of presentations.
d.Sarcoidosis.
May present with all of these features but here again purulent eye discharge is uncommon.In sarcoidosis eye involvement is quite frequent but is of different kind.Skin itch is also uncommon at presentation.
e.Finally AIDS
HIV affected children are malnourished, wasted;have prolonged fever,generalized lymphadenopathy, dermatitis. They frequently suffer from severe opportunistic infections. Dysphagia is probably due to esophageal candidiasis. Purulent eye discharge is due to some bacterial infection. Skin itch is due to some fungus infection such as pityrosporon. Thus the description of the sick child matches quite well with one with AIDS.
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