A previously healthy 7-year-old Hispanic boy presented with a 3-day history of multiple, slightly pruritic blistering lesions on both legs. He also reported right upper quadrant abdominal pain, subjective fever, and multiple episodes of emesis. He had no significant medical history, and there was no family history of skin lesions.
On physical examination, the patient's vital signs, including blood pressure levels, were normal. His skin showed multiple, grouped purpuric papules and plaques with central, hemorrhagic vesicles (Figure 1). A Nikol sky sign was negative. The rash was distributed on the upper extremities, lower extremities, and buttocks (Figure 2). Other pertinent physical findings included right upper quadrant abdominal tenderness and swollen, nontender ankles.
López ER, Bender MM, Hebert AA. Multiple Bilateral Vesiculobullous Lesions on the Lower Extremities—Quiz Case. Arch Dermatol. 2003;139(2):215-220. doi:10.1001/archderm.139.2.215-c