Case 96

Medical History

A 12-month-old male infant is brought with a history of high fever for eleven days with poor response to antipyretics. He was taken to a pediatric emergency department seven days ago, where he was misdiagnosed with upper respiratory infection and had antibiotics prescribed. However, the patient persisted with fever and developed a polymorphic exanthema on his trunk, which subsequently spread to his limbs. He has also been misdiagnosed with urticaria and unsuccessfully treated with antihistamines. On examination, the infant is feverish (102,2ºF or 39ºC) and presents with bilateral conjunctival injection, erythematous tongue, oropharynx and lips and palmar erythema.

Based on the clinical history and images provided, which is the most likely diagnosis?