Prepared by Robert S. Gillespie, MD, MPH, Pediatric Nephrologist, Riverside, Calif

A 4-year-old girl was brought to the office by her parents. They reported she was sent home from day care because of “insect bites” on her feet. The next day the rash spread to include her legs and buttocks, and her ankles were swollen and painful. The girl refused to walk because of the ankle pain but was otherwise happy and playful.

Physical examination showed she had swelling on both ankles and a rash on the legs (Figure 1), feet, and buttocks (Figure 2). Her vital signs were normal. A complete blood cell count was normal, except for a platelet count of 328 x 109/L; coagulation studies and urinalysis were normal.

What’s Your Diagnosis?

• Child abuse
• Meningococcemia
• Henoch-Schönlein purpura
• Rocky Mountain spotted fever