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JAMA Pediatrics Clinical Challenge
October 2013

A Child With Bullous Skin Lesions

Author Affiliations
  • 1University of Trieste, Trieste, Italy
  • 2Institute for Maternal and Child Health, IRCCS “Burlo Garofolo,” Trieste, Italy
  • 3Institute for Maternal and Child Health, IRCCS “Burlo Garofolo,” University of Trieste, Trieste, Italy
JAMA Pediatr. 2013;167(10):975-976. doi:10.1001/jamapediatrics.2013.2565

A 5-year-old girl presented with a 2-week history of pruritic, bullous skin lesions that had started on her lower limbs. She had been treated with topical mupirocin and oral amoxicillin–clavulanate potassium for a suspected superficial skin infection. She presented for evaluation because new lesions of similar appearance appeared on the upper limbs, trunk, vulva, and perineum despite antibiotic therapy. Physical examination revealed many large, tense bullae filled with clear fluid, rounded with an erythematous base and “rosette-like” blisters (Figure). Some of them appeared superinfected. Also the vulva and perineum had an intense erythematous rash. She was apyretic and vital parameters were normal. Laboratory tests showed a normal white blood cell count and lymphocyte subpopulations, erythrocyte sedimentation rate, and C-reactive protein level. Test results for anti-transglutaminase and antiendomysial antibodies were negative.