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 and Vietnamese people perform Gua Sha, also known as coining or spooning. It involves repeated pressured strokes over oiled skin with a smooth stone, spoon, or coin to draw out illness or fever.

•Gua Sha causes extravasation of blood from peripheral capillaries, leading to broad marks of subcutaneous ecchymosis, which can take up to four days to fade.

•Incorrect: This is often confused with abuse, but understanding the family's cultural background can help make this distinction.

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

•Incorrect: 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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