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JAMA Pediatrics Clinical Challenge

Pink-Violaceous Patches on the Lower Back, Buttocks, and Thighs of a 13-Year-Old Girl

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Colleen Helen Cotton, MD
Leslie Castelo-Soccio, MD, PhD

A 13-year-old girl with a history of Crohn disease presented to the pediatric dermatology clinic for evaluation of a rash on her buttocks and back. The patient noticed the rash 1 day prior to presentation. The rash was asymptomatic with no pain or pruritus. Fourteen days prior to presentation, the patient was seen in the emergency department for a temperature greater than 102°F. Since that time, the patient reported low-grade fever and 1 week of headache for which she had been taking ibuprofen. She also reported fatigue. She denied any preceding upper respiratory tract symptoms.

Physical examination revealed a well-nourished girl in no acute distress with approximately 10 pink-violaceous nummular and annular patches ranging from 1 to 4 cm in diameter (Figure). These patches were located on the trunk, buttocks, and thighs bilaterally. The patient’s medical history is significant for a diagnosis of Crohn disease for which she receives several long-term immunomodulatory medications with no recent changes. She has a known allergy to infliximab and had not been exposed to this drug recently. She lives in a heavily wooded area with 2 dogs and 3 cats, although she did not recall a tick bite.

See the full article for an explanation and discussion.

Author Affiliations: Cotton is affiliated with the Pediatric Residency Program, St Christopher’s Hospital for Children, Philadelphia, Pennsylvania, and Castelo-Soccio (castelosocciol@email.chop.edu) is affiliated with the Division of Pediatrics, Section of Dermatology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania.