A 10 year old boy presents with a 3 week history of weight loss, diarrhoea, vomiting and a cough. No toxin ingestion has been noted and the family denies any use of traditional medicines.

Acknowledgement
This case study was kindly provided by Dr Bhadrish J Mistry, Paediatrician, Department of Paediatrics, Chris Hani Baragwanath Hospital and the University of Witwatersrand.