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JAMA Pediatrics Clinical Challenge
February 2015

A Large, Tender Scalp Nodule in an 8-Year-Old Boy

Author Affiliations
  • 1Perelman School of Medicine at the University of Pennsylvania, Philadelphia
  • 2Section of Dermatology, Division of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
JAMA Pediatr. 2015;169(2):183-184. doi:10.1001/jamapediatrics.2014.2905

A previously healthy 8-year-old boy presented to the emergency department for evaluation of a large, tender scalp nodule. One month prior to presentation, the patient’s mother noticed multiple annular, scaly patches on the patient’s scalp and upper back. Both of the patient’s brothers developed similar patches. Two weeks before presentation, the area on the scalp grew in size, becoming a tender nodule with yellow suppurative discharge.

Results of the physical examination were notable for a somewhat tired-appearing boy with a 6-cm tender, red nodule on the right frontal scalp (Figure 1). The nodule had a boggy consistency and thick yellow crust and was draining yellow material. There was no hair within this area on the scalp. On the patient’s right upper back was an annular scaly patch; significant posterior auricular and cervical lymphadenopathy was noted bilaterally.

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