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May 2010

Severe Pruritus in an 11-Month-Old Infant—Quiz Case

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Arch Dermatol. 2010;146(5):557-562. doi:10.1001/archdermatol.2010.75-a

An 11-month-old Hispanic boy was seen for evaluation of severe pruritus. At 4 months of age, he began developing pruritic papules on his trunk and scalp, which often blistered and were noted to be aggravated by heat. Desloratadine, diphenhydramine hydrochloride, topical retapamulin, and topical hydrocortisone butyrate had been prescribed with minimal improvement. His review of systems was remarkable for nearly constant pruritus and chronic, intermittent diarrhea.

Physical examination revealed an alert and healthy infant. On his trunk were urticarial papules and plaques, and new lesions could be induced with pressure (Figure 1 and Figure 2). Subtle thickening of his skin was felt over portions of his trunk and proximal extremities. He had no hepatosplenomegaly or lymphadenopathy. A complete blood cell count showed 506 000 μL (506 × 109/L) platelets, with 6.0% monocytes, 5.1% eosinophils, and 1.7% basophils. An incisional biopsy sample was obtained and sent for histopathologic examination (Figure 3).

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