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JAMA Pediatrics Clinical Challenge
February 2017

A 15-Month-Old Boy With Blue-Gray Macules

Author Affiliations
  • 1Harvard Medical School, Boston, Massachusetts
  • 2Harvard Combined Dermatology Residency, Boston, Massachusetts
  • 3Dermatology Program, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
JAMA Pediatr. 2017;171(2):191-192. doi:10.1001/jamapediatrics.2016.2832

A 15-month-old boy with congenital heart disease, seizures, and developmental delay was admitted to the hospital for a methicillin-resistant Staphylococcus aureus retropharyngeal abscess and methicillin-resistant Staphylococcus aureus bacteremia treated with vancomycin and clindamycin. The dermatology department was consulted for a diffuse truncal rash concerning for a drug rash given the initiation of several antibiotics during his hospital stay. On admission, he was noted to have several scattered 2-mm pink papules on his trunk and extremities and a high density of blue-gray macules on his trunk. The duration of his skin lesions was unknown. He was up-to-date on all of his immunizations. He lived with his parents, aunt, uncle, and 3-year-old cousin. His cousin received a diagnosis of chicken pox 6 months prior, but had persistent skin lesions and pruritus. His mother had several pruritic pink papules on her bilateral forearms, which she suspected were from sand fleas.