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Special Feature |

Picture of the Month—Quiz Case FREE

Laura Chang, BA; Ravi Ubriani, MD; Albert C. Yan, MD
[+] Author Affiliations

Author Affiliations:University of Pennsylvania Medical School, Philadelphia (Ms Chang); Columbia University Medical Center, New York, New York (Dr Ubriani); and The Children’s Hospital of Philadelphia, Philadelphia (Dr Yan).


Section Editor: Samir S. Shah, MD


Arch Pediatr Adolesc Med. 2008;162(10):989. doi:10.1001/archpedi.162.10.989.
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A 3-year-old boy presented to an outpatient dermatology clinic for an outbreak of pustules involving his inguinal area. It then rapidly spread to his chest, abdomen, and extremities. His only other complaints were that he was feeling tired and had experienced some leg pain. He was otherwise afebrile and was eating and drinking normally. There was no family history of any similar medical conditions. On examination, he was a healthy-appearing boy with a widespread eruption characterized by erythematous, annular, and polycyclic plaques studded with numerous tiny pustules (Figure 1and Figure 2). The pustules coalesced into larger collections of pus with later rupture yielding erosions and collarettes of scale. Laboratory screening indicated mild transaminitis with an aspartate aminotransferase level of 68 U/L (to convert to microkatals per liter, multiply by 0.01667) and normal levels of alanine aminotransferase, alkaline phosphatase, calcium, and albumin. He also had an elevated white blood cell count of 15 400 cells/mL with 57% segmented neutrophils. Blood culture results were negative.

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Figure 1.

Patient's torso showing widespread erythematous, annular, polycyclic plaques studded with pustules.

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Figure 2.

Close-up view of lesions showing numerous tiny coalescing pustules superimposed on erythematous polycyclic plaques.

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Figures

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Figure 1.

Patient's torso showing widespread erythematous, annular, polycyclic plaques studded with pustules.

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Figure 2.

Close-up view of lesions showing numerous tiny coalescing pustules superimposed on erythematous polycyclic plaques.

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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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