This is the left upper arm of a 12yo girl who came in for "bites", was at a picnic 2 weeks ago but had not been hiking or camping. She had no other complaints and was generally healthy. The rash was not pruritic, and was just slightly raised. She also had multiple more typical appearing bites on her wrists and back, but this one was concerning for ECM. I ended up recommending a 21-day course of cefitin.
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