Case 2: Urgent Emergency Room Consult for Fever and Rash

History
Emergency room physician has requested an urgent consult for a 19 year old previously healthy female with chief complaint of “not feeling like her normal self” for the past 24 hours. Vitals signs on your arrival were Temperature 40 Degrees Celsius, Pulse 72, Blood Pressure 110/72. She is a fit,well-nourished female in no acute distress, but slightly unresponsive. The following photos reveal her skin findings.

(lesion is palpable and purpuric)

Questions
1) In addition to the history provided by the Emergency Room Physician, what other questions would you want to ask the patient?

2) What other physical examination findings would you look for to narrow your differential diagnosis?

3) What is your Differential Diagnosis (please include the reason for listing each diagnosis)?

4) What tests would you suggest to the Emergency Room Physician?

5) What would be your initial treatment plan?

6) Summarize your most likely diagnosis.

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