15 month old otherwise healthy. No URI sx or recent infectio | Figure 1

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15 month old otherwise healthy. No URI sx or recent infection. Rash started in R axilla and appears to have spread over 1-2 days. Has a patch of similar appearing lesions over R upper back. Lesions are non-pustular, non-vesicular. Diagnosis? #dermatology #skin #rash

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Rash was scattered and anterior to the BLE but was worse on the LLE.
On Thursday evening she complained of the rash again because it was more diffuse. At that time the petechial rash was on both LE circumferentially and on dorsolateral feet. No oral involvement. No conjunctival injection. No fevers. No symptoms. Rash was non blanchable. LLE was worse but that is her hemiparetic side.

Friday morning the rash extended beyond kneecaps in ascending manner with lacy appearance to torso and thighs that were more apparent than night prior. Lacy appearance was blanchable. Large non painful minimally raised area to back of her arms Friday morning. Blanchable and lacy appearance to both arms.

In less than an hour, the arms were diffuse affected but rash remained non petechial and more urticaria appearing or purpuric but pink in color. Palmar surfaces spared. Torso with diffuse rash as well. Not petechial. No itching during this time. She takes Zyrtec nightly. No impact on rash.

Took to doctor and got labs. All labs normal including EBV and strep. Normal platelets. Abs eos and imm grans slightly above normal. WBC normal.

Friday night began to have itching to BLE and BUE. Rash remains unchanged. Feet appear worse with lacy appearance now to bottom of feet. No known tick bites in last year.

With itching now (although not severe), I am giving her Zyrtec BID and added Pepcid this AM. Unchanged so far. Psmear still pending. Remains afebrile.

3 days prior to come, patient had undocumented fever, cough and colds. Non pruritic maculopapular to vesicular rashes appeared on 2nd day of illness started at lower extremities as verbalized by the mother. RT-PCR done for confirmation. Awaiting for the result.