A 6 year old female child presents to the emergency with a two day history of upper respiratory tract symptoms and a new rash today.  The dad reports that it started on the child's leg but it is spreading  and is painful. The child is on no medications and immunizations are up to date.

 

Exam

The child looks generally well. The rash is pictured below.  It is warm and tender to touch.  There are obvious insect  bites on all extremities.

 

What is the most likely diagnosis?

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Authors

Dr. Joanna Holland

joanna.holland@iwk.nshealth.ca

Dr. Angela Punnett

angela.punnett@sickkids.ca

Reviewer

Dr. Mumtaz Virjii

mvirji2@cw.bc.ca