A 15-month-old boy with congenital heart disease, seizures, and developmental delay was admitted to the hospital for a methicillin-resistant Staphylococcus aureus retropharyngeal abscess and methicillin-resistant Staphylococcus aureus bacteremia treated with vancomycin and clindamycin. The dermatology department was consulted for a diffuse truncal rash concerning for a drug rash given the initiation of several antibiotics during his hospital stay. On admission, he was noted to have several scattered 2-mm pink papules on his trunk and extremities and a high density of blue-gray macules on his trunk. The duration of his skin lesions was unknown. He was up-to-date on all of his immunizations. He lived with his parents, aunt, uncle, and 3-year-old cousin. His cousin received a diagnosis of chicken pox 6 months prior, but had persistent skin lesions and pruritus. His mother had several pruritic pink papules on her bilateral forearms, which she suspected were from sand fleas.
Haitz K, Walls AC, Huang JT. A 15-Month-Old Boy With Blue-Gray Macules. JAMA Pediatr. 2017;171(2):191-192. doi:10.1001/jamapediatrics.2016.2832