Photo Rounds

Rash and fever in a 14-month-old girl
A careful examination of this toddler’s rash and a thorough history led us to the correct diagnosis.
Kyoungwoo Kim, MD
Department of Family Medicine, Inje University Seoul Paik Hospital, Seoul, South Korea
kwkimfm@gmail.com
DEPARTMENT EDITOR
Richard P. Usatine, MD
University of Texas Health Science Center at San Antonio
The author reported no potential conflict of interest relevant to this article.
This work was supported by a grant from Inje University.
The fact that our 8-year-old patient’s brother and sister also complained of similar papules helped us make the diagnosis.
An 8-year-old boy was brought by his family to our clinic for treatment of 2 pruritic, inflammatory masses on his scalp. He’d had the masses for one month, and they hadn’t responded to an unknown treatment administered at a health center in Afghanistan. The edematous lesions were ulcerated with a crust, and had a diameter of approximately 6 cm and 4 cm on the frontal and occipital scalp, respectively (FIGURE 1A AND 1B).
The boy also had a well-demarcated, erythematous macule with scales on his face, but no other symptoms. The boy’s brother and sister also complained of pruritic, erythematous papules on their arms and faces. The family denied raising or having any recent contact with animals.
WHAT IS YOUR DIAGNOSIS?
HOW WOULD YOU TREAT THIS PATIENT?
A careful examination of this toddler’s rash and a thorough history led us to the correct diagnosis.
An AP chest x-ray provided no clues as to the cause of the patient’s substernal chest pain. Two other x-ray views, however, made the diagnosis...
Our patient sought treatment for the nodules on his nose, but the nodules on his tattoos proved particularly helpful in making the diagnosis.