A previously healthy 14-year-old boy developed right-sided neck pain, tachycardia, a diffuse erythematous rash, and subjective fevers over 2 days. He sought medical attention in a local urgent care clinic, where he had a negative Sars-CoV-2 antigen test and was referred to the local emergency department (ED) for persistent tachycardia and further workup. After fluid resuscitation, his tachycardia was not improved, so he was admitted to the Pediatric Hospital Medicine Service. Physical examination showed large areas of erythema and erythroderma of multiple body sites, perioral sparing, increased erythema in flexor skin folds, posterior soft palate petechiae, and a white strawberry tongue. There was a small, tender lesion with surrounding erythema without discharge on his right neck thought to be a possible entry point for infection. Laboratory results showed thrombocytopenia, normal white blood cell count, normal hemoglobin concentration, absolute lymphopenia, and an elevated C-reactive protein (CRP) to 130 mg/L. He was started on intravenous fluids and antibiotics for a presumed infectious cause of the rash and laboratory findings. The next morning, an expanded diagnostic workup was undertaken including electrocardiogram, echocardiogram, ferritin, triglycerides, liver enzymes, lactate dehydrogenase (LDH), brain natriuretic peptide, coagulation studies, and fibrinogen. With treatment and supportive care, his tachycardia and energy improved, so he was discharged with oral antibiotics and follow-up with the Infectious Disease Clinic in 2 days. When seen in follow-up, he was immediately admitted to the hospital for worsening fatigue, tachycardia, and new findings that prompted multiple consultations, and transfer to pediatric critical care services.

中文翻译：

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一名 14 岁男孩，患有颈部疼痛、发烧和弥漫性红斑。

一名既往健康的 14 岁男孩在 2 天内出现右侧颈部疼痛、心动过速、弥漫性红斑和主观发热。他在当地一家紧急护理诊所就医，在那里他的 Sars-CoV-2 抗原检测呈阴性，并被转诊到当地急诊科 (ED) 进行持续性心动过速和进一步检查。液体复苏后，他的心动过速没有好转，于是住进了儿科医院内科。体格检查示全身多处大面积红斑和红皮病，口周不受影响，屈肌皱襞红斑增多，后部软腭瘀点，草莓舌白。他的右颈部有一个小而柔软的病变，周围有红斑，没有分泌物，被认为是感染的可能入口点。实验室结果显示血小板减少、白细胞计数正常、血红蛋白浓度正常、绝对淋巴细胞减少和 C 反应蛋白 (CRP) 升高至 130 mg/L。他开始接受静脉输液和抗生素治疗，因为皮疹和实验室检查结果被认为是感染性原因。第二天早上，进行了扩展的诊断检查，包括心电图、超声心动图、铁蛋白、甘油三酯、肝酶、乳酸脱氢酶 (LDH)、脑利钠肽、凝血研究和纤维蛋白原。经过治疗和支持治疗，他的心动过速和精力得到改善，因此他出院并口服抗生素并在 2 天后到传染病门诊随访。随访时，他因疲劳加重、心动过速、