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Special Feature |

Picture of the Month—Quiz Case FREE

Dipesh D. Duttaroy, MS, MBBS; Jitendra Jagtap, MS, MBBS; Ujjwal Bansal, MS, MBBS; Bithika Duttaroy, MD, MBBS
[+] Author Affiliations

Samir S. Shah, MD
Albert C. Yan, MD


Arch Pediatr Adolesc Med. 2007;161(12):1211. doi:10.1001/archpedi.161.12.1211.
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Published online

An 11-year-old boy presented with low-grade fevers and a year-long history of multiple nodules involving his face, neck, and axillae. A number of these nodules had ruptured during this period, resulting in seropurulent discharge from the lesions. Aside from topically applied herbal remedies, he had not taken any other medications. During this period, he weighed 20 kg and had lost about 5 kg during the past 12 months.

Cystic lesions were present in the right and left parotid region (Figure 1), along with multiple matted lymph nodes in the anterior and posterior triangles of the neck, with multiple discharging sinuses. Irregular ulcers, nodules, and plaques were present over the neck, upper chest, and axillae, with crusting, scarring, and dusky red discoloration of the surrounding area (Figure 2).

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Figure 1.

The left (A) and anterior (B) profile of the head, neck, and chest of the patient.

Graphic Jump Location

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Figure 2.

The right profile of the face (A) and left axilla (B) of the patient.

Graphic Jump Location

A laboratory evaluation revealed a low hemoglobin level of 9.4 g/dL (normal, 11.0-15.0 g/dL). His erythrocyte sedimentation rate was 60 mm/h (normal, ≤15 mm/h), and his total leukocyte count was 9000/μL (normal, 4000/μL-11 000/μL). (To convert hemoglobin to grams per liter, multiply by 10; and to convert total leukocyte count to numeral times 109 per liter, multiply by 0.001.) The result of the enzyme-linked immunosorbent assay for human immunodeficiency virus infection was negative. The result of chest radiography was normal.

Figures

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Figure 1.

The left (A) and anterior (B) profile of the head, neck, and chest of the patient.

Graphic Jump Location
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Figure 2.

The right profile of the face (A) and left axilla (B) of the patient.

Graphic Jump Location

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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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