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Picture of the Month Quiz

A 9-year-old boy with a history of an autism spectrum disorder presented with a 3-day history of fever and a rash consisting of a mixture of pink papules and petechial lesions. The lesions were distributed on the distal upper and lower extremities with greater intensity distally vs proximally (Figure 1). There was also an unusual concentration on the right side of the face and chin (Figure 2). The papular component was partially blanchable. The patient also exhibited conjunctival hyperemia bilaterally and small (1-2 mm) white erosions with surrounding erythema involving the lip and palatal mucosae. No arthralgias or arthritis was observed. The parents report that this current illness began approximately 3 days after their son had received a live-attenuated intranasal influenza vaccine.

Image of pink papules and petechial lesions

Figure 1.

Image of pink papules and petechial lesions

Figure 2.

What is your diagnosis?

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