[b]A 6 yo boy has not been feeling well for the last week. He had a low grade temp, joint pains, and abdominal pain with occasional vomiting. His mother became more concerned this morning when she noticed he had a rash on the back of his legs. He appears tired but , does not seem to be in acute distress. His VS: TEMP—100.6F,pulse---100/min,RR---20/min, BP---100/70 mm Hg.Eyes r anicteric & tympanic membranes are normal. Abdomen soft with active bowel sounds and mild diffuse tenderness, no mass or organomegaly. there r well defined hyperemic macules scattred over the backs of the legs & buttocks, with a rare lesion on the back of the arms. Some r raised and palpable and none blanch with pressure.Other PE is normal.LABS: WBC---9900/mm3,hct—42%,platelets---320,000/mm3, stool for occult blood positive,ESR---18 mm/h,U/A---2+protein with RBCS and WBC casts……… [/b]

Most likely diagnosis……….
1.ITP
2.KAWASAKI DS.
3.RMSF
4.HENOCH-SCHONLEIN PURPURA
5.SYSTEMIC JRA
6.MENINGOCOCCEMIA

The best next step in treatment……
1.IVIG
2.ORAL.DOXYCYCLINE
3. NSAIDS
4.IV CORTICOSTEROIDS5. IV CEFTRIAXONE
6. IV INFLIXIMAB