An Infant with Worsening Rash.

Abstract

A 3-month-old boy presented with 2 weeks of a worsening rash that started around his mouth. His mother suspected irritation from his pacifier, but the rash continued to spread, prompting a visit to an urgent care center. He was diagnosed with impetigo, and he received oral amoxicillin and topical mupirocin to little effect. He had been afebrile from the start, without any symptoms of upper respiratory infection, respiratory distress, hair loss, vomiting, or diarrhea. He breast-fed well from his adoptive mother since shortly after birth (she was nursing 1 of her biological children at the same time), and the mother had no dietary restrictions. There were no similar rashes in his adoptive siblings. After failing to respond to antibiotic therapy, the boy was sent to a dermatologist, who performed a punch biopsy. When the pathology results became available, the patient's family was directed to bring him to the emergency department. As depicted in Fig. 1, the physical examination revealed numerous erythematous and heme-crusted plaques with “flaky paint” scale on …