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January 1994

Crusted Scalp Nodule in an Infant

Author Affiliations

Medical University of South Carolina, Charleston

Arch Dermatol. 1994;130(1):105-106. doi:10.1001/archderm.1994.01690010109018

REPORT OF A CASE  A small pustule consistent with an arthropod bite developed on the left parietal scalp of a 3-month-old boy. A papule developed at the site, which slowly enlarged over the following month despite two courses of systemic antibiotics. On admission, the boy had left cervical lymphadenopathy (3×5 cm) with torticollis to the right, left posterior occipital lymphadenopathy, and a left parietal erythematous nodule (1×2 cm) with an eroded, crusted surface (Figure 1). The physical examination was otherwise normal. The complete blood cell count and differential and erythrocyte sedimentation rate were normal. A chest roentgenogram demonstrated left cervical lymphadenopathy. A skin biopsy specimen was obtained from the left parietal nodule on the scalp (Figure 2 and Figure 3), which showed a suppurative and granulomatous dermatitis and folliculitis. The papillary and reticular dermis were composed predominantly of granulation tissue with occasional ruptured follicles surrounded by a marked neutrophilic

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