Happy Monday, everyone! See if you can guess this patient’s fascinating condition.
A 6 year old boy is brought to the Emergency Room by his mother because he has a rash covering his arms and legs for one day. The rash started out on the patient’s wrists and ankles, and then spread to involve his entire limbs. The patient’s mother also says he has been feeling ill for the last five days. He has felt warm, though the mother did not measure his temperature. The boy has also been complaining of achy arms and legs, headache, and sleepiness. The mother mentions they got back from vacation in Georgia visiting relatives last week. During that time, the family spent a lot of time outdoors, and when pressed, the child states he “saw a bug biting him.” No one else in the family is sick.
On physical exam, the patient is found to be lethargic. He has a fever of 103° Fahrenheit, and his heart rate is normal (i.e. not as fast as you might expect with such a high fever). The rash is covering the boy’s arms and legs, with some spots found on his trunk (rash shown below). His exam is also notable for diffuse muscle and joint tenderness.
What is the most likely diagnosis?