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Special Feature
November 01, 2010

Picture of the Month—Quiz Case

Author Affiliations



Copyright 2010 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2010

Arch Pediatr Adolesc Med. 2010;164(11):1065. doi:10.1001/archpediatrics.2010.194-a

A 9-year-old boy with a history of an autism spectrum disorder presented with a 3-day history of fever and a rash consisting of a mixture of pink papules and petechial lesions. The lesions were distributed on the distal upper and lower extremities with greater intensity distally vs proximally (Figure 1and Figure 2). There was also an unusual concentration on the right side of the face and chin (Figure 3and Figure 4). The papular component was partially blanchable. The patient also exhibited conjunctival hyperemia bilaterally and small (1-2 mm) white erosions with surrounding erythema involving the lip and palatal mucosae. No arthralgias or arthritis was observed. The parents report that this current illness began approximately 3 days after their son had received a live-attenuated intranasal influenza vaccine.

Figure 1.
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Multiple petechial lesions on the distal upper extremity.

Figure 2.
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Multiple petechial papules on the bilateral lower extremities.

Figure 3.
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Unilateral distribution of facial petechiae, frontal view.

Figure 4.
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Unilateral distribution of facial petechiae, chin and neck view.

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