Painful, Purpuric Plaques in a Child With Fever

Abstract

<h3>REPORT OF A CASE</h3> A previously healthy 4-year-old black girl was admitted to the hospital for fever, leg pain, and rash. The illness began 2 weeks earlier with rhinorrhea, spiking fevers, and a nonproductive cough. She was evaluated at another institution 5 days prior to admission for leg pain, fever, and a seizure. A viral syndrome was diagnosed and the seizure was attributed to the fever. Despite treatment with ibuprofen, the myalgias, arthralgias, and fever continued. Nausea, vomiting, and a painful rash developed 1 day prior to admission. There was no personal or family history of infections, bleeding disorders, or known exposure to anyone with a febrile illness. On physical examination, the child was febrile (temperature, 38.2°C) but alert and in no acute distress. Her neck was supple and results of the neurologic examination were normal. Her tonsils were red and swollen without exudate. There was nontender anterior and posterior