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JAMA Pediatrics Clinical Challenge

A Child With Bullous Skin Lesions

Image of figure 1


Giulia Paloni, MD
Alison Shardlow, MD
Massimo Maschio, MD
Irene Berti, MD
Andrea Taddio, MD
Alessandro Ventura, MD

A 5-year-old girl presented with a 2-week history of pruritic, bullous skin lesions that had started on her lower limbs. She had been treated with topical mupirocin and oral amoxicillin–clavulanate potassium for a suspected superficial skin infection. She presented for evaluation because new lesions of similar appearance appeared on the upper limbs, trunk, vulva, and perineum despite antibiotic therapy. Physical examination revealed many large, tense bullae filled with clear fluid, rounded with an erythematous base and “rosette-like” blisters (Figure). Some of them appeared superinfected. Also the vulva and perineum had an intense erythematous rash. She was apyretic and vital parameters were normal. Laboratory tests showed a normal white blood cell count and lymphocyte subpopulations, erythrocyte sedimentation rate, and C-reactive protein level. Test results for anti-transglutaminase and antiendomysial antibodies were negative.

See the full article for an explanation and discussion.

Author Affiliations: Paloni and Shardlow are affiliated with the University of Trieste, Trieste, Italy, Maschio and Berti are affiliated with the Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste, Italy, and Taddio (ataddio@yahoo.it) and Ventura are affiliated with the Institute for Maternal and Child Health, IRCCS “Burlo Garofolo,” University of Trieste, Trieste, Italy.