Review Question - QID 212511

A 7-year-old boy is brought to the emergency room by his father for fever and sore throat lasting 2 days. The patient reports that “my throats hurts as if I am swallowing glass.” He feels “hot” and reports that he sweats through his pajamas at night. His father gave him some acetaminophen yesterday, but it did not seem to help. During his shower yesterday, the patient noticed some “red dots” on his arms that do not itch or hurt. His past medical history is unremarkable and he is up to date on all his vaccinations. Physical examination reveals a soft, musical murmur at the left lower sternal border that is louder in the supine position. His arms and torso show a fine, erythematous rash that blanches with pressure. A picture of his tongue is shown in Figure A. What is the most likely pathophysiology of this patient’s condition?