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May 2013

Diffuse Umbilicated Vesicles in a Critically Ill Child

Author Affiliations

Author Affiliations: Departments of Dermatology (Drs Chang and Sosa) and Pathology (Dr Cassarino), Kaiser Permanente Los Angeles Medical Center, Los Angeles, California.

JAMA Dermatol. 2013;149(5):641-642. doi:10.1001/jamadermatol.2013.2512

Methicillin-resistant Staphylococcus aureus (MRSA) septicemia can produce disseminated skin lesions, but a vesicular eruption is not a well-recognized presentation of this infection.

A 10-year-old boy developed right knee pain but no open wounds after being hit with a shopping cart and the next day complained of pain in the opposite knee. Over the next several days, he developed multiple-joint effusions, fever, lethargy, lung infiltrates, proteinuria, and pyuria. He had been treated with a 10-day course of trimethoprim/sulfamethoxazole 1 month earlier for a nasal ulcer and possible abscess. His medical history included epistaxis, atopic dermatitis, pneumonia, asthma treated with steroid inhalers, and hypothyroidism. The patient was admitted to the pediatric intensive care unit with hypotensive shock, acute respiratory distress syndrome, pancytopenia, and disseminated intravascular coagulation. He was intubated and started on a regimen of 2 vasopressors, stress-dose steroids, acyclovir, and broad-spectrum antibiotics including vancomycin.

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