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JAMA Pediatrics Clinical Challenge
July 2017

Abrupt Onset of Pustules in a Child

Author Affiliations
  • 1Columbia University College of Physicians and Surgeons, New York, New York
  • 2Department of Dermatology, University of Texas Southwestern Medical Center, Dallas
JAMA Pediatr. 2017;171(7):703-704. doi:10.1001/jamapediatrics.2017.0357

An 18-month-old boy with a history of atopic dermatitis presented to the emergency department with a 2-day history of high fever and rash that began 2 days after completing an 8-day course of clindamycin for sinusitis.

On presentation, the child was lethargic and fussy, with a temperature of 38.1°C. Physical examination revealed a strikingly symmetrical eruption of erythematous, edematous, annular plaques with superimposed small pustules at the periphery, and associated desquamation (Figure, A and B). The eruption was accentuated in the inguinal folds, antecubital fossae, and popliteal fossae. Laboratory evaluation was significant for leukocytosis with neutrophilia (26000 μL; to convert to × 109 per liter, multiply by 0.001). Neutrophil levels were 66.7% (to convert to proportion of 1.0, multiply by 0.01), and lymphocyte levels were 9.9% (to convert to proportion of 1.0, multiply by 0.01). C-reactive protein and erythrocyte sedimentation rate levels were within normal limits. Test results for anti-DNase B antibodies, a respiratory viral panel, and blood and throat cultures were all negative.

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