An 8-year-old girl presents to the emergency department (ED) of a large, tertiary care children’s hospital in central Wisconsin during the late summer. Three weeks earlier she was playing at a lake near her home in southeastern Wisconsin and sustained a bug bite to her left lateral neck. She presented to a local clinic, where she was diagnosed as having a local reaction to a bee sting and was treated with hot and cold compresses, diphenhydramine, and cetirizine. During the next 10 days the area continued to swell, and a rash began to form around the site, as well as some bloody discharge. She returned to the local clinic, where she was started on cephalexin for presumed abscess, and a culture of the bloody discharge was obtained. She took only a few doses of the antibiotic due to stomach upset. Three days later, when the skin changes persisted and swelling...

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