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Special Feature
November 2, 2009

Picture of the Month—Quiz Case

Author Affiliations



Copyright 2009 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2009

Arch Pediatr Adolesc Med. 2009;163(11):1061. doi:10.1001/archpediatrics.2009.202-a

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).

Figure 1.
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Solitary nonhealing erythematous plaque with central crust on the left cheek.

Figure 2.
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Mild residual telangiectatic erythema 5 months after therapy.

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