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Special Feature
February 07, 2011

Picture of the Month—Quiz Case

Author Affiliations
 

SAMIR S.SHAHMD, MSCE

Arch Pediatr Adolesc Med. 2011;165(2):177-178. doi:10.1001/archpediatrics.2010.281-a

A previously healthy 19-year-old white woman was hospitalized with a 4-day history of a rash of unknown etiology. The rash began with an erythematous papule on her right cheek 4 days prior to admission that ulcerated and formed a black eschar. Three days prior to admission she developed a similar lesion on her nose. One day prior to hospitalization, she noted multiple genital lesions. She was hospitalized for diagnostic evaluation after developing a temperature, measured orally, of 100.0°F and additional lesions on the dorsal aspect of both hands. The lesions were mildly pruritic. Associated symptoms included a mild headache and a 1-day history of myalgias.

On admission she appeared healthy, with normal vital signs. She had an enlarged submandibular lymph node and inguinal lymphadenopathy. A dermatologic examination revealed an approximately 1-cm in diameter central eschar surrounded by a raised, cream-colored ring with an erythematous base extending approximately 3 cm around the lesions located on her nose and right cheek (Figure 1). There were bilateral erythematous pustules on her hands. There were 2 crusted papules of the suprapubic area and 4 ulcerative lesions on her vulva (Figure 2).

Figure 1.
Photograph of the facial lesions at the time of hospital admission.

Photograph of the facial lesions at the time of hospital admission.

Figure 2.
Photograph of vulvar lesions at the time of hospital admission.

Photograph of vulvar lesions at the time of hospital admission.

See http://www.archpediatrics.org for the Picture of the Month Web Quiz: What is your diagnosis?

What is your diagnosis?

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