A 7-year-old Chinese child presents to the emergency room with her parents. The child is febrile and hypotensive. The nurse observes red, welt-like lesions covering the child's back. What is the most likely cause of these lesions?


•Some traditional Chinese people perform Gua Sha, also known as coining or spooning.

•Gua Sha involves repeated pressured strokes with a coin or spoon in order to rid the body of illness.

•This is often confused with abuse when done to children, but understanding the family's cultural background can help make this distinction.

•Rock Mountain spotted fever is caused by the Rickettsial bacterium and presents with a maculopapular rash and petechial rash.

•A type III hypersensitivity reaction, or immune complex reaction, occurs when antigen-antibody complexes form and give rise to an inflammatory response. A rash can develop.

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