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A previously healthy early childhood patient, residing in Portugal, presented to the emergency department with fever (maximum temperature of 39.8°C) lasting for 12 hours, along with vomiting, anorexia, prostration and the development of a petechial rash that appeared 4 hours earlier. On examination, she was haemodynamically stable, with a blood pressure of 90/70 mm Hg and a heart rate of 96 beats per minute. A maculopapular erythematous rash covered her entire body, with scattered petechiae primarily affecting the limbs ( figure 1). No other clinical evidence of disseminated intravascular coagulation was found. Differential diagnosis included bacterial meningitis and sepsis, but viral exanthems and scarlet fever were also considered. Initial laboratory tests revealed leukocytosis with neutrophilia, normal platelet count and a C-reactive protein of 24.8 mg/L. Coagulation tests showed a slightly elevated prothrombin time (14.7 s), D-dimer (830 mg/mL) and fibrinogen (377 mg/dL). Cerebrospinal fluid (CSF) analysis revealed five white blood cells/mm³, protein 19 mg/dL and glucose 61 mg/dL, without evidence of glucose consumption. Differential white cell count in the CSF was not available, which represents a limitation. Blood and CSF cultures were collected, and empirical treatment with intravenous ceftriaxone (100 mg/kg/day) and fluids was initiated.