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A 23-year-old Hispanic woman presented with a 1-month history of rash, arthritis, and fever. The patient was in excellent health until 1 month prior to presentation, when she noted the spontaneous onset of a pruritic rash that began on her face and then progressed to involve her trunk and extremities. Shortly afterward, she developed pain and swelling of both hands, particularly of her wrists and metacarpophalangeal (MCP) joints. One week prior to presentation, she noted a sore throat and diffuse body aches together with subjective fevers and chills. She denied drenching sweats during febrile episodes. On evaluation in an emergency department, she was afebrile and had a diffuse erythematous rash that spared her palms and soles and mucous membranes. Laboratory evaluation showed a normal complete blood cell count, normal chemistries, including liver tests, and a normal urinalysis. The erythrocyte sedimentation rate (ESR) was 35 mm/hour (normal value Յ20) and the C-reactive protein (CRP) level was 53 mg/liter (normal value Ͻ3

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