Clinician's Corner

Abstract

five-month-old female infant who was born at24 weeks gestational age presented with a five-weekhistory of an erythematous eruption that began in the per-ineum. It progressed to involve the entire lower face, withareas of excoriations and erythematous crusted patchesaround the mouth and distal extremities.The rash did not respond to oral nystatin or topicalterbinafine. Due to the persistence of the rash and an inter-current upper respiratory tract infection, the patient pre-sented to the emergency department. Upon review ofsystems, the patient had mild diarrhea and no history ofalopecia. She was exclusively breastfed. The patient’s pasthistory included respiratory distress syndrome, bronchopul-monary dysplasia, retinopathy of prematurity and gastroe-sophageal reflux disease.Physical examination revealed an irritable infant. Shehad an axillary temperature of 37.8°C. The rest of her vitalsigns were normal. She had multiple confluent macu-lopapular lesions over her perioral and perineal area(Figures 1 and 2), with erosions, desquamation and crust-ing. Her fingers and toes were similarly affected, with spar-ing of the inframammary, labial and gluteal creases. Therest of the examination was normal.The infant was admitted to hospital and started onintravenous cloxacillin for impetigo. A diagnostic test wasperformed on admission, which revealed the diagnosis.