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JAMA Pediatrics Clinical Challenge
October 2014

Grouped Hemorrhagic Vesicles

Author Affiliations
  • 1University of Mississippi Medical Center, Jackson
  • 2Department of Dermatology, University of Mississippi Medical Center, Jackson
JAMA Pediatr. 2014;168(10):965-966. doi:10.1001/jamapediatrics.2013.5396

An 8-year-old girl presented to the dermatology clinic for further evaluation of a lesion over the right posterior thigh (Figure, A). Her mother reported the lesion appeared at age 3 months, was previously diagnosed as a hemangioma, and was treated with observation. She also reported the lesion originated as a “cystlike papule” that had continuously expanded. In addition to causing cosmetic concerns, the lesion seemed to be irritated by clothing and would occasionally bleed and swell. The patient denied pain or itching associated with the lesion. Since its appearance at 3 months of age, several abscesses formed underneath the region of concern requiring incision and drainage. Medical history revealed no other medical problems. On physical examination, at the proximal posterior thigh, there was an 11 × 10-cm cobblestoned, gray plaque composed of numerous purplish, vesicular papules with surrounding satellite papules. No swelling was present. A 4-mm punch biopsy was performed (Figure, B and C).

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