The 5-year-old boy lay in his grandmother’s arms. “My feet, my feet,” he wailed. She unwrinkled the tangled bangs away from his forehead then reached for her phone. She wasn’t persuaded what was going on with her grandson, but she had cared for enough children and grandchildren to understand that something was really wrong. His feet were swollen and annoying and so were his hands. On his legs there was a rash that exploded in excess of the several hours he was at her house into a series of raised red rings. She call oned her son and daughter-in-law. The little boy needed to go to the hospital.He’d always been delicate, his mummy explained to the triage nurse at the E.R. of Lowell General Hospital in Lowell, Mob. If one of his brothers had a runny nose, he’d get a runny nose and a fever. He was sick so again that she’d once taken him to the pediatrician to see if there was anything wrong with his unaffected system. The pediatrician assured her that it was a typical response to starting kindergarten, when first-time undergraduates would catch all the viruses going around. Just the previous week he had an lousy cold. But he’d never had anything like this.Perhaps an InfectionIt started with a stomachache the endlessly before. The boy was up for hours. Then in the early morning, when his father embraced him to the bathroom, he noticed that the tip of the boy’s penis was red and inflamed. As soon as his wife awakened, he acknowledged her about the situation and took him to the hospital.The child was seen right away. He didn’t must a fever and was drinking well, though reluctant to eat. He said he didn’t obtain a stomachache anymore, and his belly wasn’t tender. His penis, though red, didn’t seem to hurt, either. But his white-blood-cell count was elevated, and that offered the child had an infection. The E.R. doctor figured he probably had balanitis, an infection of the leading position of the penis, and gave him a week of an oral antibiotic.When the boy was discharged from the facility late that morning, the father called the boy’s grandmother. Could she look after him? He and his mate had to work, and the child and his grandmother were very close.When they arrived at the family of his Lela — that’s how the boy pronounced abuela, the Spanish word for grandmother — he didn’t lack to walk. He held up his arms in that familiar wordless plea: Carry out d kill me. When his father picked him up and took him to his grandmother, she received him happily, and he nestled into her arms.Scary SwellingHe slept for much of the afternoon but ate and drag ones feet used when he was awake. In the evening, the boy seemed feverish — hot and uncomfortable. His grandmother disclosed him a bath. As she washed him, she saw what looked like a couple of bites on his legs. When it was anon a punctually to get out of the tub, he refused to stand up. He said his feet hurt. And when his abuela looked, his feet were puffy. His indexes, too, seemed larger than normal, as if they had been blown up as if balloons. Even his face looked swollen — his eyelids were distended, and his lips have all the hallmarked enormous. And what she thought were bites were now strange red form a lines that snaked around his legs onto his thighs and belly. She upbraided her daughter-in-law. Something’s not right, she told her. He needs to go back to the hospital.The materfamilias left work and hurried to her mother-in-law’s house. To her maternal eye, her little boy looked in the mood for a monster — he was so strangely swollen.ImageCredit…Photo illustration by Ina JangShe lash out ated him into his car seat and sped off to the hospital. She carried the boy to the front desk; she was perturbed that the swelling of his lips could extend and cut off his airway, she told the triage suckle. The nurse was concerned, too, and they quickly took him into the busy crisis room.A Dangerous PossibilityThe child was cranky and didn’t want to be tested. Both of his feet were obviously swollen. So were his hands and mug. He cried when anyone tried to move his hands and feet. And he had this itchy, spreading flood. The E.R. doctor worried about a rare but potentially dangerous disease of the smallest blood boats called Henoch-Schönlein Purpura (H.S.P.). (It has recently been renamed IgA vasculitis.) An autoimmune confuse, it primarily affects children and is characterized by a triad of symptoms: abdominal hurt, arthritis and a rash.The rash is caused by the affected vessels leaking blood into the adjacent tissues. When this happens close to the surface of the skin, it forges dark red or bruise-colored spots. When these lesions are pressed, they don’t change-over color. But the boy’s rash was a light, not dark color, and when touched those glimpses lost the pink coloring and became pale. H.S.P. also causes a kick over the traces in inflammatory markers in the blood, so the doctor ordered a test to look for that as immeasurably. Those markers were slightly elevated, and so to be safe, the E.R. doctor determined to admit the child to the hospital to be monitored overnight. She ordered ibuprofen for the irritation and an antihistamine for the itch.Finding a New DiagnosisThe next morning, the boy was seen by Dr. Krista Birnie, a pediatric hospitalist. By then he looked varied comfortable, though he still didn’t want anyone to touch his tumid hands or feet. It probably wasn’t H.S.P., Birnie decided, now that she saw the youngster. Although the boy didn’t want to move his hands or feet, it looked to her as if that was because of the protrusion rather than some form of arthritis, a symptom of H.S.P. And the pink discs of rash had not turned into the angry red blotches characteristic of H.S.P.The child’s parents reported that the heedless started out looking like hives, which then grew into enlarge oning circles and faded away — only to be replaced by others. The E.R. doctor had also gone phut a test for Lyme disease. There was a field behind the boy’s house where he time after time played, and it could harbor deer ticks. Birnie didn’t mull over this looked like the typical Lyme rash, though Lyme complaint was a common infection in northern Massachusetts.An Allergic ReactionBirnie was thinking along contrary lines. This child had first come into the hospital with a lesion on his penis. Neutral 12 hours later that lesion was gone. And the boy’s parents well-known that his lesions were transient like hives. There was a disease Birnie had heard of but never seen called Urticaria multiforme (U.M.). It’s a order of allergic reaction, she remembered, seen in kids usually after a viral infection, but Birnie couldn’t call to mind more than that. After her rounds, she found a computer and looked up the sickness. The description fit this child perfectly. It’s an allergic response triggered by either a medication or more commonly a viral infection. This lassie had a cold the week before.The allergic reaction causes a release of histamine, a association chemical that causes (among other things) plasma to let slip out of blood vessels, causing hives and the characteristic swelling of the feet, manual labourers and face. It is usually treated with antihistamines — to block the histamine. The boy had an antihistamine on divulgence because he felt itchy. There’s no test for Urticaria multiforme, but foreordained his symptoms, Birnie felt confident he had it. Still, she wanted to watch him one more day.Slowly Uphold to NormalThe next morning the child was a little less swollen, admitting that he continued to get new hives. The Lyme test hadn’t come back, but Birnie was dulcet sure that when it did, it would be negative. The child had a follow-up designation with his primary doctor a couple of days later. Birnie telephoned a few days after that to make sure the boy was feeling better. He was. And she was lawful — the Lyme test was in fact negative.To the boy’s mother, this was just one profuse illness experienced by her delicate child. But it made an impression on him. Three years later, when he on tells his mother that his feet hurt, she knows that sours he’s feeling sick.