A white male, 18 years of age presented at the emergency room with

a severe headache, vomiting, and a stiff neck with pain running up his back. On

admission, his temperature was 101F. The young man appeared to have trouble

hearing during the nurse’s interview and also seemed to have trouble

concentrating.

The history revealed that he is a wrestler for the local high

school team. He had felt as though he were getting a cold the past few days,

since his last meet in Hicksville. He did not smoke or drink, but he had

attended a party two days earlier thrown by his girlfriend and the other

cheerleaders to celebrate his victory in the sectionals. He had been holding

his weight at 162 for the season, so he ate little and did not drink on the day

of meets (today is a day of the meet).

On physical exam, the physician noticed several areas of small

purplish spots on the skin of the back, thigh and arm. The boy thought those

were from wrestling.

Which of the following is the most likely diagnosis?