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JAMA Dermatology Clinicopathological Challenge
May 2018

Nonhealing Crusted Scalp Lesions in a 4-Year-Old Boy

Author Affiliations
  • 1Department of Dermatology, Venereology and Allergology, University of Leipzig, 04103 Leipzig, Germany
  • 2Department of Pediatric Hematology/Oncology/Hemostaseology, Children's Hospital, University of Leipzig, 04103 Leipzig, Germany
JAMA Dermatol. 2018;154(5):607-608. doi:10.1001/jamadermatol.2017.5638

A 4-year-old boy presented to our department of dermatology with a 3-year history of nonhealing crusted scalp lesions. He had previously been treated with various topical glucocorticosteroids and antibiotics without improvement. The physical examination revealed multiple disseminated erythematous papules, petechial hemorrhages, and yellowish crusts on the scalp (Figure, A). The remaining skin and mucosal surfaces, as well as neck, axillary, and inguinal lymph nodes, were unremarkable. The patient did not show any other obvious abnormalities, but his mother reported occasional otitis media. The family history was negative for skin disease. Routine blood examinations revealed no pathological findings. A whole-body magnetic resonance imaging (MRI) scan showed 2 osteolytic lesions on the right frontoparietal skull (Figure, B). A punch biopsy specimen of an erythematous papule on the scalp was obtained and stained with hematoxylin-eosin for histopathological analysis (Figure, C). In addition, immunohistochemical stainings were performed (Figure, D).