A 3-year-old girl without a clinically significant medical history was seen in the emergency department (ED) with violaceous circular lesions on her extremities that were present for 1 day and a 2-day history of cough, rhinorrhea, and low-grade fever. She was treated with ibuprofen and guaifenesin and discharged to home after normal findings on a complete blood cell count. She returned to the ED 6 hours later with enlarging purpuric macules, increasing in number, on her face, ears, and extremities and was referred for a dermatology consult.