RT Journal
A1 Huber C, Cozzio A, Berger C, Weibel L
T1 PIcture of the month—quiz case
JF Archives of Pediatrics & Adolescent Medicine
JO Archives of Pediatrics & Adolescent Medicine
YR 2009
FD November 1
VO 163
IS 11
SP 1061
OP 1061
DO 10.1001/archpediatrics.2009.202-a
UL http://dx.doi.org/10.1001/archpediatrics.2009.202-a
AB 
A 3-year-old girl presented to our hospital with a 20-month history of a nonhealing crusted lesion on her left cheek. The lesion had suddenly appeared as a red patch with some swelling and occasional oozing. There was no previous trauma. Treatment with topical and systemic antibiotics and topical corticosteroids did not alter the lesion. The family had 2 pet cats, and a travel history revealed a trip to Greece 2 years earlier. On examination there was a solitary erythematous plaque with central crusting and mild swelling measuring 2 × 2 cm on the left cheek but no lymphadenopathy (Figure 1). Bacterial and fungal swab test results were negative and complete blood cell count, C-reactive protein, and renal and liver function test results were normal. A skin biopsy was performed and the histopathologic examination was consistent with a mixed granulomatous inflammation. Periodic acid-Schiff, Brown-Brenn, Ziehl-Neelson, and Giemsa staining as well as tissue cultures for fungi and bacteria, including mycobacteria, were negative. Following appropriate treatment, the lesion resolved completely (Figure 2).