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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).

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

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

Figure 2.
A radiograph of the left ankle demonstrates subcutaneous, radio-opaque lesions (arrows).

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

Figure 3.
A photomicrograph demonstrates mature lamellar bone (arrows) in the epidermis and dermis (hematoxylin-eosin).

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

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