الملخص الإنجليزي
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.
