Picture of the Month Quiz

Image of a 12-year-old boy with nonverbal autism developed a 2-month history of petechiae and bruising followed by worsening musculoskeletal pain and refusal to walk


A 3-month-old African American boy presented to the dermatology clinic for evaluation of scalp lesions that were not improving with topical or oral antifungal medications. These lesions were present at birth but enlarged by 2 weeks of age. The infant had no other systemic symptoms. Maternal history was significant for mixed connective tissue disease.

Physical examination revealed a thriving infant with 2 erythematous plaques with well-demarcated borders and central atrophy on the left parietal scalp and postauricular region (Figure). The remainder of his physical examination was unremarkable. Laboratory studies revealed an elevated aspartate aminotransferase level of 339 U/L (reference range, 10-60 U/L) and alanine aminotransferase level of 364 U/L (reference range, 5-50 U/L) (for both values, to convert to microkatals per liter, multiply by 0.0167) but an otherwise normal complete blood cell count and normal comprehensive metabolic profile.

For a complete discussion of this month's case, read the Picture of the Month—Quiz Case.