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Picture of the Month Quiz

A 6-year-old girl presented with a 3-week history of papular lesions that had begun on her right hand and subsequently spread to the rest of her body. The lesions had grown rapidly to attain the present size. The lesions were nonpruritic and not tender. The parents reported a history of weight loss and chronic diarrhea over the last 3 months. There were no associated fevers, blistering, or mucosal involvement. Physical examination showed an emaciated child with hyperkeratosis of the skin and angular cheilitis suggestive of nutritional deficiency. Multiple 0.5 × 0.5-cm cervical axillary and inguinal lymph nodes were palpable. She was covered with multiple umbilicated smooth nodules with a waxy surface ranging in size from 0.2 to 5 cm (Figure). The lesions were surrounded by an erythematous halo. More than 500 lesions were noted, covering the entire body with the exception of the palms and soles.

Figure

Figure.

What is your diagnosis?

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