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A 5-month-old Hispanic boy, previously healthy, presents to the emergency department (ED) for 5 days of fever, 3 days of diarrhea and rash, and 2 days of vomiting. He had been diagnosed with acute otitis media by his primary care physician 3 days prior to his presentation and started on amoxicillin. The parents brought their son to the ED because of his persistent fever up to 104°F and decreased oral intake. He has no recent travel and no known sick contacts. His immunizations are up to date and he has never been hospitalized. He was born in the United States, full term with an uncomplicated birth history.

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The parents of a healthy 5-month-old boy bring him to the office for evaluation of an enlarging yellowish nodule on the back of his right thigh. It started as a pink macule several months ago and became yellow and lumpy over the last month. The infant was born at term and has grown and developed normally. His parents deny any trauma, but report occasional bleeding from the surface of the nodule. They deny any new medications or outdoor exposures. There is no history of new topical skin products.