A 6-year-old Caucasian boy with a past medical history of eczema presents to the pediatric emergency department with 12 days of worsening bilateral anterolateral leg pain and edema that has resulted in refusal to ambulate. His mother noted an atypical rash on the boy’s anterior shins, which has persisted despite application of hydrocortisone cream. Other symptoms include low energy, low-grade fever, nausea, poor oral intake, and persistently dry and bleeding lips. Immunizations are up-to-date, and he has had no sick contacts. The only medication he has received is ibuprofen for pain. Developmental milestones are appropriate for age, and the boy has no dietary restrictions. The only finding of note in the family is rheumatoid arthritis in the paternal great-grandmother. The boy has been evaluated by his primary care physician, and laboratory results, including complete blood cell count, Lyme studies, antinuclear antibody, and C-reactive protein, are within normal limits. He has...

You do not currently have access to this content.