A 14yr old boy with fever lymphadenopathy and peripheral cyanosis

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I've been given this case to solve in an attempt to understand the topic of "patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations and come up with a diagnosis and treatment plan.

This is a case of 14 year old boy resident of Narketpally who was admitted with the chief complaints of -

Fever since 14 days

Loose stools since 14 days

Vomitings since 14 days

Bluish black discoloration on tips of fingers since  11 days

History of presenting illness:

Patient was apparently asymptomatic 14 days ago then he developed high grade fever sudden in onset, gradually progressive, evening rise of temperature, associated with chills and rigors, generalized weakness and fatigue and not releived on medication. 

Cervical, inguinal lymphadenopathy was noticed

No h/o weight loss, night sweats

Loose stools since 14 days, watery, foul smelling, non blood stained, around 4-6 times a day

Vomitings since 14 days, immediately after solid or liquid food intake,non projectile,bilious, non foul smelling non blood stained, food as content

Yellowish discoloration at the tips of fingers since 14 days, turned to bluish since 12 days and bluish black since 11 days. Burning sensation over the palmar surface of both the hands.

Past history:

H/o trauma to 

No h/o similar complaints in the past

No h/o blood transfusions

No h/o HT DM asthma TB

FAMILY HISTORY:

No similar complaints in the family.

Personal history:

Diet- mixed

Appetite- normal 

Bowel and bladder movements- Regular

No Allergies

No Addictions

General physical examination:

Patient is concious coherent and cooperative well oriented to time place and person

No pallor 

No icterus, clubbing, lymphadenopathy, cyanosis

Vitals:- 

Temperature:

RR

BP

HR

Systemic examination:-

CVS- 

Inspection: 

shape of chest wall- elliptical

No scars, sinuses, visible pulsations

Palpation- 

No thrills heave felt

Apical impulse palpable at left 5th ICS along midclavicular line 

Percussion:

Heart borders percussed- no abnormalities noted

Auscultation:

All areas of heart auscultated

S1, S2 heard no murmurs heard

Respiratory system:

Shape of chest - scaphoid

Movements of chest wall - b/l symmetrical expansion with respiration

No scars sinuses

Trachea - central

Normal vesicular breath sounds heard

GIT:

Shape of abdomen- scaphoid

No scars, sinuses, visible pulsations

No tenderness in quadrants of abdomen

Soft, no organomegaly

Bowel sounds heard

CNS: 

NFND, power tone normal

Reflexes present