A week before, she had been examined in the emergency department for widespread pruritic erythematous-edematous plaques associated with
remittent fever (up to 38.5 [degrees]C) and sore throat.
The acute systemic phase of illness begins abruptly with a high
remittent fever (38o to 40o C) and headache, chills, rigors, and myalgias; conjunctival suffusion without purulent discharge; abdominal pain; anorexia, nausea and vomiting; diarrhea, and cough and pharynigitis; a pretibial maculopapular cutaneous eruption occurs rarely.