A 2-Year-Old-Boy With an Alarming Facial Rash

Buraa Kubaisi, MD; Nakhoul Nakhoul, MD; C. Stephen Foster, MD


January 22, 2019

Physical Examination and Workup

Upon physical examination, the child appeared ill, with generalized aches, malaise, and a fever (103°F [39.44°C]). A generalized erythema with targetlike lesions and associated central purpura and bullae was found mainly on his trunk and extremities. An example of a similar appearance in an adult is shown in Figure 1. The child also had ulcerations on the surface of his lips and his tongue. The ulcers were tender on palpation and hemorrhagic in appearance.

Figure 1.

Ocular examination revealed acute conjunctivitis, with subconjunctival hemorrhage in both eyes associated with hemorrhagic ulcerations of the eyelids, and watering and yellow discharge from both eyes.

The child was hospitalized for supportive care. Blood and urine samples were obtained. Laboratory workup was done and revealed mild anemia, nonspecific low-grade leukocytosis, and elevated interleukin-6 (IL-6) and C-reactive protein (CRP) levels. Electrolytes and other chemistries were normal. Urine analysis revealed no pathology.

A dermatologist was consulted, and a skin biopsy was performed. Skin biopsy histopathology revealed full-thickness necrosis of the epidermis with mild dermal inflammatory cell infiltration (Figure 2).

Figure 2.


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