A 6-year-old boy with no chronic medical problems or recent illnesses presents to the emergency department with 6 days of fever (up to 105°F [40.6°C]), abdominal pain, and severe myalgia. He denies sore throat, nasal congestion, cough, vomiting, diarrhea, and rash. There are no known sick contacts, and he has not traveled. He has had exposure to stray kittens outside his rural home in southeast Texas. On physical examination he is febrile to 101.9°F (38.8°C) and ill-appearing. He has red lips, shotty bilateral cervical lymphadenopathy, and diffuse tenderness to palpation of the abdomen and bilateral lower extremities. He has full range of motion and no swelling, erythema, or warmth over his extremities but does not walk due to pain. Laboratory values include a white blood cell count of 6,000/μL (6×109/L) with 57% bands, hemoglobin level of 11 g/dL (110 g/L), and platelet count of 137×103/μL (137×10...

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