I am working in a very rural ED and just saw a 13 y/o female wholooks relatively healthy. She came in with c/o a rash to bilateral upper and lower extremities but none to face or torso, the rash actually looks like hives and the local MD concurred. The pt also presents with a persistant cough, fever presently 100.4 (o) and states this has been going on for approximately 1 1/2 weeks, cxr clear bmp nl but wbc 2.6 with the rest of the cbc nl. Pt traveled out of area two weeks ago for scool event, no one else with these symptoms reported. My concerns are we missing the obvious?