Abstract

A 14-year-old boy presents with rash, fever, chills, and difficulty walking due to right hip pain. The patient had been healthy until 2 weeks ago when he developed muscle pain, headaches, sore throat, cough, and de-creased appetite. Ten days ago, he was started on a course of azithromycin for “bronchitis. ” Rapid streptococcal antigen and mononucleosis antibody tests were negative at that time. Three days later, the antibiotic regimen was changed to a second-generation cephalosporin for a pre-sumed urinary tract infection after red blood cells ap-peared in the urine. Urine nitrite and leukocyte esterase were negative. Three days later (and 4 days prior to presentation), the patient developed right shoulder pain, fever, “sores ” in his mouth, blood-streaked sputum, frequent episodes of