A 13-MONTH-OLD infant with methylmalonic acidemia presented with an erythematous, desquamating rash that had begun in the diaper area and progressively spread to involve parts of the face, extremities, and trunk (Figure 1 and Figure 2). As part of his treatment for methylmalonic acidemia, dietary protein was restricted (1.2 g/kg per day). Before the rash began, he had gastroenteritis and was not able to tolerate this diet for 3 days.
Sasaki M, Aikoh H, Sugai K, Yoshida H, Tunnessen WW. Picture of the Month. Arch Pediatr Adolesc Med. 1998;152(7):707-708. doi:10.1001/archpedi.152.7.707