Red Book Online Presents: Diagnosis Detective | June 2024
Editor: Kristina A. Bryant, MD, FAAP
Case contributed by Nadia Hill, MD, Pediatric Infectious Disease Fellow, Children's Hospital of Philadelphia
A 14-year-old previously healthy female presents with four days of fever, diarrhea, headache, and rash. She returned from a month-long trip to the Dominican Republic one week ago. While in the Dominican Republic, she spent time at the beach, swimming in lakes and pools, and exploring the nearby regions. She had several bug bites on the trip. Three days after returning to the US, she developed fever as high as 102.8 F, non-bloody diarrhea, headache, myalgias, a "pinpoint" rash on arms and legs, and gingival redness. On exam, she appeared tired and had a faint, sparse macular erythematous rash on her arms and legs, a few petechiae on her arms, and two healing insect bites on her left forearm.
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