“My daughter has got it again. She had to be hospitalized last time and no one knows what it is. Please help.” We didn't practice on Saturdays, but early this Saturday morning we met a seven-year-old girl for an emergency evaluation of a fiery red rash, which was symmetrical on her cheeks, armpits, groin, and buttocks. It had come out just four hours ago and her mother was frantic. This was the third time her daughter had been stricken, each time in the same exact areas.

We learned that the first attack had occurred two years ago following a cough and runny nose, and had necessitated three days of hospitalization. There was no fever. Treatment with aspirin and an antihistamine resulted in fading of the rash without any trace later that week. Extensive studies revealed no cause for the rash, so the noncommittal diagnosis of “toxic erythema” was made. The second attack came just ten months ago. Again, no cause could be found, but hospitalization and treatment with intramuscular cortisone was necessary.

We continued with the history. Her parents and a three-year-old brother had remained well on each occasion. Yet, on this Saturday morning the girl looked and felt sick. Her joints were tender and swollen. She had complained of malaise the previous night and had slept poorly. The only medication given had been a teaspoonful of Night Time Cold Formula®, which contained pain relievers, a cough suppressant, and a decongestant.