Sign In
Individual Sign In
Create an Account
Institutional Sign In
OpenAthens Shibboleth
Special Feature
November 3, 2008

Picture of the Month—Quiz Case

Author Affiliations

Samir S.ShahMDAuthor Affiliations:Departments of Pediatrics, Walter Reed Army Medical Center, Washington, DC (Drs Darling and Bauer), and Uniformed Services University, Bethesda, Maryland (Dr Bauer).


Copyright 2008 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2008

Arch Pediatr Adolesc Med. 2008;162(11):1091. doi:10.1001/archpedi.162.11.1091

A previously healthy 4.5-month-old boy presented for evaluation of a rash over his distal extremities and trunk. The rash had been present for about 1 month and seemed to be increasing in number, size, and location. Medical history and family history were unremarkable. His examination was significant for a tender, erythematous, atrophic-appearing, nodulopapular rash over the trunk and lower and upper extremities. Nodular areas were superficial, firm, and mobile (Figure 1). He was growing at the third percentile for length and 1 SD lower than the third percentile for weight. He was also noted to have round facies and normal-length metacarpals and metatarsals. Radiography of a lower extremity lesion was performed (Figure 2) as well as a skin biopsy (Figure 3) and laboratory evaluation.

Figure 1.
Image not available

Close-up photograph demonstrates erythematous, atrophic, nodulopapular rash.

Figure 2.
Image not available

A radiograph of the left ankle demonstrates subcutaneous, radio-opaque lesions (arrows).

Figure 3.
Image not available

A photomicrograph demonstrates mature lamellar bone (arrows) in the epidermis and dermis (hematoxylin-eosin).