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A 16-year-old girl presented with fever, rash, and diffuse pain for 5 days. She reported a pruritic, painful rash on her hands and feet and multiple painful joints.
Animal exposures included 3 new puppies and rodent infestation in the home and neighborhood cats. She did not report recent travel or arthropod bites.
On examination, her right elbow and left knee were swollen and warm. She reported pain with passive movement of the right shoulder and left wrist. Petechial and pustular lesions were present on both hands and palms (Figure, A). Her feet, including the soles, had many petechial lesions and a few purpuric lesions (Figure, B).
Crews JD, Palazzi DL, Starke JR. A Teenager With Fever, Rash, and Arthralgia. JAMA Pediatr. 2014;168(12):1165-1166. doi:10.1001/jamapediatrics.2014.1604