Fever, a rash, and a … “bug bite”?

A 3-year-old, previously healthy girl presented to the emergency department with fever, fatigue, rash, and eye redness. According to her parents, beginning 1–2 days before, the child grew tired, had a tactile fever, then developed a whole body rash that included her palms. On presentation, she had generalized fatigue, cough, post-tussive vomiting, watery non-bloody diarrhea, and anorexia. There was also a large painful swelling over the child’s right shin that looked like a "bug bite". Inflammatory markers were elevated. While initially stable on broad-spectrum antibiotics, the girl progressed into hypotensive shock and was transferred to the intensive care unit.