case_images: PMC6589315_01
case_images: Skin rash over face and neck along with extensive blistering lesions with mucosal involvement.
case_images: CRIID2019-5471765.001.jpg
case_images: PMC6589315_01_CRIID2019-5471765.001.jpg
case_images: fig1
case_images: A 17-year-old young female from Kathmandu, Nepal, presented to the emergency department of the Institute of Medicine (IOM) with a generalized painful skin rash along with extensive blistering with mucosal involvement for one day (Figures 1-3).
case_images: Skin rash over the back of trunk.
case_images: CRIID2019-5471765.002.jpg
case_images: PMC6589315_01_CRIID2019-5471765.002.jpg
case_images: fig2
case_images: A 17-year-old young female from Kathmandu, Nepal, presented to the emergency department of the Institute of Medicine (IOM) with a generalized painful skin rash along with extensive blistering with mucosal involvement for one day (Figures 1-3).
case_images: Skin rash with bullae formation.
case_images: CRIID2019-5471765.003.jpg
case_images: PMC6589315_01_CRIID2019-5471765.003.jpg
case_images: fig3
case_images: A 17-year-old young female from Kathmandu, Nepal, presented to the emergency department of the Institute of Medicine (IOM) with a generalized painful skin rash along with extensive blistering with mucosal involvement for one day (Figures 1-3).
case_images: Clumping of red blood cell along the surface of the tube at 4 C.
case_images: CRIID2019-5471765.004.jpg
case_images: PMC6589315_01_CRIID2019-5471765.004.jpg
case_images: fig4
case_images: After incubation at 4 C for 3 minutes, macroscopic hemagglutination was observed as cell clumping in thin film of blood that clinged to the tube (Figure 4).
case_images: Disappearance of clumping while heating the tube at 36 C.
case_images: CRIID2019-5471765.005.jpg
case_images: PMC6589315_01_CRIID2019-5471765.005.jpg
case_images: fig5
case_images: The clumping disappeared when the tube was warmed at 35.8 C and reappeared at 4 C (Figure 5).
case_images: Clumping of red blood cell at 4 C in slide.
case_images: CRIID2019-5471765.006.jpg
case_images: PMC6589315_01_CRIID2019-5471765.006.jpg
case_images: fig6
case_images: Also, serial dilutions of the patient's serum were mixed with an equal volume of 0.2% washed human O group erythrocytes, and clumping was observed till titer of 1 : 128 dilution after leaving at 4 C overnight (Figure 6).
case_images: Disappearance of clumping while heating the slide at 37 C.
case_images: CRIID2019-5471765.007.jpg
case_images: PMC6589315_01_CRIID2019-5471765.007.jpg
case_images: fig7
case_images: The clumping is dissociated at 37 C (Figure 7).
case_images: Patient improving on azithromycin and supportive treatment.
case_images: CRIID2019-5471765.008.jpg
case_images: PMC6589315_01_CRIID2019-5471765.008.jpg
case_images: fig8
case_images: The same treatment was continued and her clinical symptoms improved (Figure 8).