A 34-year-old African-American female presented to her primary care doctor complaining of feeling fatigued over the past month. Initially she thought she was coming down with a cold, but as her fatigue continued she assumed her symptoms were stress related. Five days ago she became concerned when she developed a fever of 101°. She also noted a rash forming on her face. On physical examination the patient is ill-appearing. Right paratracheal and cervial lymph nodes are swollen, moveable and nontender, and there is a reddish-brown papular rash around the nasolabial folds and the periorbital areas of her face. The rash is asymptomatic. No history of recent infections, travel, or allergies. Past medical history is unremarkable. Only medication is a multivitamin.