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JAMA Pediatrics Clinical Challenge
June 2016

A Widespread Pruritic Rash With Facial Swelling and Black Streaks

Author Affiliations
  • 1Harvard Combined Medicine and Dermatology Residency Program, Harvard Medical School, Massachusetts General Hospital, Boston
  • 2Department of Dermatology, Boston Children’s Hospital, Boston, Massachusetts
JAMA Pediatr. 2016;170(6):617-618. doi:10.1001/jamapediatrics.2015.3741

A healthy girl aged 4 years presented with a 5-day history of a pruritic rash on her arms, neck, axillae, and face. The rash started as small pink bumps on her arms that spread to involve the axillae, neck, and upper chest. Four days prior to arrival, she developed significant redness and pruritus of her face. On arrival, her parents noted black streaks on her right arm, prompting an urgent emergency department evaluation. Treatment prior to presentation included diphenhydramine, cetirizine, and a 20-mg dose of prednisone without improvement. The patient was otherwise healthy with normal development and growth. She had a history of mild atopic dermatitis and was not taking any medications. She had no known history of drug allergy or contact allergy. The patient lived with her 2 siblings and both parents, who were all asymptomatic. She had no pets and no recent travel, and her vaccinations were up to date.

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