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Download the article PDF: Clinical Image Challenges November 2025
A 16-year-old male presents to urgent care accompanied by his father due to acute onset of fever, abdominal pain, fatigue, altered mental status, and a lower-extremity rash. Symptoms began earlier the same day. The patient denies recent upper respiratory symptoms, medication use, travel, or trauma.
On physical examination, he appears acutely ill and febrile to 103.1°F (39.5°C). Neurologic assessment reveals altered mental status. Dermatologic exam shows retiform, violaceous purpuric plaques with maroon borders on both legs as shown in image provided.
View the image taken and consider what your diagnosis and next steps would be. Resolution of the case is described on the following page.
