The doctor, you quickly help to see it, the child is how? ” 4 o’clock in the afternoon, four worried parents with a 4, 5-year-old girl hurried into the Infection Clinic. After the patient questioning of the doctor, it turns out that the child is from Rizhao, fever 5 days ago, the next day the whole body appeared red rash, and accompanied by right hip pain, to the local hospital, was diagnosed as “scarlet fever ”, given penicillin drug treatment for 4 days, but the child continues to high fever, the rash does not improve, and the appearance of pustular rash, for further diagnosis and treatment, the parents brought it to our hospital The parents brought him to our hospital for further treatment. The doctor found that the child’s skin was densely covered with corn-like red papules, his tongue was strawberry-shaped, more pustular rashes were seen scattered on his back, his liver and spleen were not large, his hip joint was not red and swollen, and the routine blood test that day showed a high total white blood cell count and a high neutrophil ratio. The application of penicillins, which are effective in treating “scarlet fever” for 4 days without improvement, has put a heavy question mark on the diagnosis of “scarlet fever” again. After a brief discussion, we locked the diagnosis in two areas, 1) infectious rash caused by a severe bacterial infection, and 2) severe scarlet fever. The child was then prescribed CRP, blood culture, anti“O” and other laboratory tests, and hip x-ray was taken to clarify the cause of hip pain. In close cooperation with the Department of Laboratory and Radiology soon reported the results, CRP 200mg/L, confirming that the child had a serious bacterial infection, and the X-ray was normal, ruling out septic lesions of the hip joint. Because the anti“O” results can not be returned immediately, “scarlet fever” can not be ruled out, therefore, that night the child to stay in the observation room of the Infection Department to choose sensitive antibiotics anti-infective treatment. The next morning when the ward inspection, the child’s skin pustules have been significantly reduced, the infection seems to have been controlled, but the child still continues to be high fever, Sun Jianlan, director of the child’s meticulous examination, found that the child’s right lower abdominal pressure pain is obvious, and then asked the medical history, the parents said the child had said the day of the onset of stomach pain, the 5 days sometimes pain and sometimes not, did not attract the attention of parents, so yesterday did not say to the doctor. So, Director Sun immediately decided to abdominal ultrasound examination of the child, the results soon returned – periappendiceal abscess, referred to surgical treatment. In the afternoon, the anti & ldquo;O” results returned, 〈150, ruling out the diagnosis of & ldquo;scarlet fever”. The child recovered quickly after surgery. So, what caused this child to be misdiagnosed for 5 days? First, due to his age, the child’s description of the pain points was inaccurate, describing abdominal pain as hip pain and atypical symptoms of appendicitis, misleading the focus of the doctor’s examination. Second, the child’s typical “scarlet fever” characteristics limited the physician’s thinking, and he failed to adjust his diagnostic thinking in the treatment process at the right time. Third, the physician’s awareness of comprehensive and systematic examination needs to be further strengthened. Although our diagnosis and treatment of this child was timely and correct, we should still learn from the misdiagnosis of this case in order to further improve our medical care so that we can better serve our patients.