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.
Patient's torso showing widespread erythematous, annular, polycyclic plaques studded with pustules.
Close-up view of lesions showing numerous tiny coalescing pustules superimposed on erythematous polycyclic plaques.
Chang L, Ubriani R, Yan AC. Picture of the Month—Quiz Case. Arch Pediatr Adolesc Med. 2008;162(10):989. doi:10.1001/archpedi.162.10.989