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Special Feature
Octomber 6, 2008

Picture of the Month—Quiz Case

Author Affiliations

Author Affiliations:University of Pennsylvania Medical School, Philadelphia (Ms Chang); Columbia University Medical Center, New York, New York (Dr Ubriani); and The Children’s Hospital of Philadelphia, Philadelphia (Dr Yan).




Copyright 2008 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2008

Arch Pediatr Adolesc Med. 2008;162(10):989. doi:10.1001/archpedi.162.10.989

A 3-year-old boy presented to an outpatient dermatology clinic for an outbreak of pustules involving his inguinal area. It then rapidly spread to his chest, abdomen, and extremities. His only other complaints were that he was feeling tired and had experienced some leg pain. He was otherwise afebrile and was eating and drinking normally. There was no family history of any similar medical conditions. On examination, he was a healthy-appearing boy with a widespread eruption characterized by erythematous, annular, and polycyclic plaques studded with numerous tiny pustules (Figure 1and Figure 2). The pustules coalesced into larger collections of pus with later rupture yielding erosions and collarettes of scale. Laboratory screening indicated mild transaminitis with an aspartate aminotransferase level of 68 U/L (to convert to microkatals per liter, multiply by 0.01667) and normal levels of alanine aminotransferase, alkaline phosphatase, calcium, and albumin. He also had an elevated white blood cell count of 15 400 cells/mL with 57% segmented neutrophils. Blood culture results were negative.

Figure 1.
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Patient's torso showing widespread erythematous, annular, polycyclic plaques studded with pustules.

Figure 2.
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Close-up view of lesions showing numerous tiny coalescing pustules superimposed on erythematous polycyclic plaques.