A 6-YEAR-OLD girl had an 8-month history of papules on the interphalangeal joints of both hands. She was otherwise healthy. On physical examination her upper eyelids were erythematous, and the malar prominences were erythematous and slightly indurated (Figure 1). Violaceous papules were present over the proximal interphalangeal and metacarpophalangeal joints of both hands (Figure 2). Telangiectasia were present in the nail cuticles of the fingers (Figure 3). No other abnormalities were detected on physical examination. Muscle strength was normal. The parents reported that the facial erythema had been present for 2 years with exacerbations related to sun exposure. Results of laboratory investigations, including complete blood cell count, serum chemical analysis, aldolase and creatinine kinase levels, and antinuclear, anti–double-stranded DNA, anti-Ro, anti-La, and anti-Jo antibody measurements, were normal. An electromyogram and magnetic resonance image of the thigh were unremarkable.
Agustin Toll, Asunción Vicente Villa, Eulalia Baselga, Antonia González Enseñat, Walter W. Tunnessen. Picture of the Month. Arch Pediatr Adolesc Med. 2000;154(12):1263. doi:10.1001/archpedi.154.12.1263