An 11-year-old boy presented to the Sultan Qaboos University Hospital (SQUH), Muscat, Oman, in 2016 with a one-week history of scattered nodular-like erythematous lesions over the arms, petechial rashes over the dorsa of both feet and itchy maculopapular urticarial rashes over both thighs [Figure 1]. He had a high-grade fever which reached 39.5 ° C as well as a headache, generalised body pain and swelling around the joints. The patient lived in Muscat and had no known history of tick bites, travel or contact with animals. A systemic examination revealed hepatomegaly and splenomegaly (both organs enlarged to 3 cm below the costal margin) as well as generalised body tenderness, myalgia and meningism. The bilateral knee and ankle joints were swollen with some restriction in movement, mainly flexion with partial extension. All vital signs were stable and normal, except for the persistent high-grade fever, which responded only partially to antipyretic medications.