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Picture of the Month—Quiz Case FREE

Jason S. Reichenberg, MD; Mark D. P. Davis, MD
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Section Editor: Albert C. Yan, MD
Assistant Section Editor: Samir S. Shah, MD

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Arch Pediatr Adolesc Med. 2006;160(8):801. doi:10.1001/archpedi.160.8.801.
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A previously healthy 15-year-old boy came to the emergency department with severe prostration associated with a worsening rash. The eruption had begun as red macules on his palms 4 days previously and rapidly progressed to involve all areas of his skin. He also had painful ulcerations in his mouth and uncomfortable redness of his eyes.

On physical examination, he was lethargic and hypotensive, with a blood pressure of 80/30 mm Hg. Discrete and confluent erythematous patches and plaques, many of which were targetoid (Figure 1), involved 95% of his skin. There was distinct palmar involvement (Figure 2) and central facial swelling with bilateral conjunctivitis (Figure 3). He had ulcerations in his mouth and on his glans penis.

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Figure 1.

Patient's back showing discrete and confluent erythematous patches, many with a targetoid appearance, that involved approximately 95% of the trunk and extremities.

Grahic Jump Location

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Figure 2.

Targetoid macules and patches involving the palms.

Grahic Jump Location

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Figure 3.

Facial edema, conjunctival injection, erosions, and crusting of lips.

Grahic Jump Location

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Figures

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Figure 1.

Patient's back showing discrete and confluent erythematous patches, many with a targetoid appearance, that involved approximately 95% of the trunk and extremities.

Grahic Jump Location
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Figure 2.

Targetoid macules and patches involving the palms.

Grahic Jump Location
Place holder to copy figure label and caption
Figure 3.

Facial edema, conjunctival injection, erosions, and crusting of lips.

Grahic Jump Location

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Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

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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.
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