A 3-year-old girl presented to our hospital with a 20-month history of a nonhealing crusted lesion on her left cheek. The lesion had suddenly appeared as a red patch with some swelling and occasional oozing. There was no previous trauma. Treatment with topical and systemic antibiotics and topical corticosteroids did not alter the lesion. The family had 2 pet cats, and a travel history revealed a trip to Greece 2 years earlier. On examination there was a solitary erythematous plaque with central crusting and mild swelling measuring 2 × 2 cm on the left cheek but no lymphadenopathy (Figure 1). Bacterial and fungal swab test results were negative and complete blood cell count, C-reactive protein, and renal and liver function test results were normal. A skin biopsy was performed and the histopathologic examination was consistent with a mixed granulomatous inflammation. Periodic acid-Schiff, Brown-Brenn, Ziehl-Neelson, and Giemsa staining as well as tissue cultures for fungi and bacteria, including mycobacteria, were negative. Following appropriate treatment, the lesion resolved completely (Figure 2).
Solitary nonhealing erythematous plaque with central crust on the left cheek.
Mild residual telangiectatic erythema 5 months after therapy.
What is your diagnosis?
Huber C, Cozzio A, Berger C, Weibel L. Picture of the Month—Quiz Case. Arch Pediatr Adolesc Med. 2009;163(11):1061. doi:10.1001/archpediatrics.2009.202-a