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Special Feature
December 2007

Picture of the Month—Quiz Case

Author Affiliations

SAMIR S.SHAHMDIndividualAuthorALBERT C.YANMDIndividualAuthor


Copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2007

Arch Pediatr Adolesc Med. 2007;161(12):1211. doi:10.1001/archpedi.161.12.1211

An 11-year-old boy presented with low-grade fevers and a year-long history of multiple nodules involving his face, neck, and axillae. A number of these nodules had ruptured during this period, resulting in seropurulent discharge from the lesions. Aside from topically applied herbal remedies, he had not taken any other medications. During this period, he weighed 20 kg and had lost about 5 kg during the past 12 months.

Cystic lesions were present in the right and left parotid region (Figure 1), along with multiple matted lymph nodes in the anterior and posterior triangles of the neck, with multiple discharging sinuses. Irregular ulcers, nodules, and plaques were present over the neck, upper chest, and axillae, with crusting, scarring, and dusky red discoloration of the surrounding area (Figure 2).

Figure 1.
Image not available

The left (A) and anterior (B) profile of the head, neck, and chest of the patient.

Figure 2.
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The right profile of the face (A) and left axilla (B) of the patient.

A laboratory evaluation revealed a low hemoglobin level of 9.4 g/dL (normal, 11.0-15.0 g/dL). His erythrocyte sedimentation rate was 60 mm/h (normal, ≤15 mm/h), and his total leukocyte count was 9000/μL (normal, 4000/μL-11 000/μL). (To convert hemoglobin to grams per liter, multiply by 10; and to convert total leukocyte count to numeral times 109 per liter, multiply by 0.001.) The result of the enzyme-linked immunosorbent assay for human immunodeficiency virus infection was negative. The result of chest radiography was normal.

What is your diagnosis?