Pharyngoconjunctival Fever with Atypical Gastrointestinal and CutaneousManifestations: A Pediatric Case Report

Abstract

Pharyngoconjunctival fever (PCF) is a distinct clinical syndrome characterized by high fever, pharyngitis, and non-purulent conjunctivitis, typically following human adenovirus (HAdV) infection. While adenovirus is generally a self-limiting condition in immunocompetent patients, it can present as a "Pandora’s box" of atypical systemic complications. This report describes a 10-year-old male presenting with the classic PCF triad alongside significant hematemesis and a widespread maculopapular rash. The clinical course was complicated by respiratory distress requiring supplemental oxygen and two episodes of gastrointestinal hemorrhage (~500 mL) followed by melena. Diagnostic confirmation was achieved via polymerase chain reaction (PCR) of throat and conjunctival swabs, which were positive for Adenovirus. Laboratory investigations ruled out common differentials including Dengue, Kawasaki disease, and Scarlet fever. Following supportive management with intravenous proton pump inhibitors, ophthalmic steroids, and respiratory support, the patient achieved full clinical resolution without sequelae. This case highlights the necessity for clinicians to recognize gastrointestinal and cutaneous manifestations as rare but possible components of the PCF spectrum to avoid diagnostic delays and ensure appropriate supportive intervention.