We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Special Feature |

Pathological Case of the Month FREE

Giampaolo Ricci, MD; Annalisa Patrizi, MD; Domenico Misciali, MD; Massimo Masi, MD
[+] Author Affiliations

Section Editor: Enid Gilbert-barness, MD

Arch Pediatr Adolesc Med. 2001;155(2):195-196. doi:10.1001/archpedi.155.2.195.
Text Size: A A A
Published online

A FEBRILE 10-year-old girl was referred for evaluation of a diffuse febrile papulovesicular eruption present for 5 days consisting of rare sparse vesicles with a tiny erythematous halo and some papules on the trunk and legs with mild itching (Figure 1 and Figure 2). Her temperature had fluctuated between 38°C and 40°C, and on the third day, the family pediatrician began acyclovir treatment (800 mg, 5 times daily) for suspected varicella infection, which she had had 4 years prior. The cutaneous lesions increased in number and size, some showing central necrosis. Her history was otherwise unremarkable. Few cutaneous lesions were present on the head; the palms of her hands, soles of her feet, and mucous membranes were spared.

Findings from laboratory examinations included a high white blood cell count (12.7 × 109/L) with increased neutrophils (8.3 × 109/L), normal values for circulating lymphocytes (2.2 × 109/L) and eosinophils (1.0 × 109/L), and a slight increase erythrocyte sedimentation rate (28 mm/h). Levels for serum immunoglobulin and circulating immunocomplex were normal. Findings from biochemical examination, antinuclear antibody tests, and Waaler Rose test were negative. Findings from hepatitis A, B, and C panels and toxoplasma antibodies were negative. Epstein-Barr virus titers showed positivity only for IgG and Epstein-Barr nuclear antigen, while titers for IgM were negative. Urinalysis showed mild microhematuria and proteinuria. Results of viral, fungal, and bacterial cultures from the vesicles and pustules as well as blood cultures were negative. A skin punch biopsy of 4 mm was obtained from a papular lesion (Figure 3). Antipyretic therapy was administered. Seven days after admission her temperature gradually decreased, and the lesions disappeared after another 7 days with mild residual hypopigmented scars. No recurrences were observed at 1-year follow-up.




Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

9 Citations

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections