A 9-year-old boy presented for evaluation of a facial rash, which was made more prominent by sunlight and stress (Figure 1). The rash first appeared 4 years before referral, shortly after a hospital admission for pneumococcal meningitis. The patient had never complained of constitutional symptoms. His medical history was significant for many episodes of sinusitis, pharyngitis, and otitis media. His sister also had chronic sinusitis and a history of pneumococcal meningitis. Physical examination showed large, scaly erythematous plaques in a malar distribution and no other skin findings. We obtained a punch biopsy specimen from the right cheek (Figure 2).
Spence SW, Cosgrove BF, Ford MJ. Malar Rash in a Child—Quiz Case. Arch Dermatol. 1999;135(10):1267-1272. doi:10.1001/jamadermatol.58602