Grace is an eight-year-old girl of Taiwanese ancestry who presents with a three-week history of intermittent fever, fatigue and headache and two days of rash affecting the face, neck and hands.

Test your clinical know-how by taking the quiz below. If you select the wrong answer, have another go — you can try as many times as you like!

Grace is an eight-year-old girl of Taiwanese ancestry who presents with a three-week history of intermittent fever, fatigue and headache and two days of rash affecting the face, neck and hands (pictured).

There is associated arthralgia.

There are no coryzal or gastrointestinal symptoms and COVID-19 and respiratory PCR tests are negative.

Grace is usually well. There is no recent history of medication use, apart from paracetamol given in the past 24 hours.

On examination she is febrile at 38.3°C, with pallor and rash as shown, and non-tender cervical and axillary lymphadenopathy.

Investigations reveal pancytopenia, positive rheumatoid factor (RF), speckled pattern antinuclear antibody and anti-Ro/SSA, elevated ESR and microalbuminuria.

Epstein-Barr virus, CMV, HSV and mycoplasma serology are negative.