13 yrs old male child presnted with a h/o fever since 2 weeks, developeda maculo papular erythematous rash all over the body on 3 day of fever.on 8 th day rash faded but fever persisted. there was sever cheilitis with lip cracking on fifth day of fever.fever subsided on 10 th day but again started on 13 th day. there was a h/o increased bowel movements during the episode.h/o cough +.h/o throat pain+.h/o desquamation from ther finger tips from the 10 th day on wards including feet. on examination child was sick looking malnourished pallor+ cyanosis-jaundice- jugulo diagastric lymphadenopathy+ posterior cervical nodes both sides palpable no pedal edema vitals stable systemic examinations normal on investigations Hb is 11 gm% platelet 5.48 lacks ESR is 70 1sthr, 140 2nd hrs all oter investigations normal including CBP