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Diagnosis Detective - June 2024

June 4, 2024

Diagnosis Detective: Can you solve it?
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.

© 2024 American Academy of Pediatrics. All rights reserved.

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