Abstract
A previously healthy 5-year-old boy presented with symptoms of fever, vomiting, and diarrhea for three days. He had extensive erythematous skin lesions mainly over his bilateral lower limbs. His parents were nonconsanguineous, and his two younger sisters were healthy. On arrival, he was in septic shock, thus requiring multiple fluid boluses, triple inotropes, and ventilation. The skin lesions started as macules that enlarged into papules and vesicles. Over the next 24 h, they rapidly evolved into multiple hemorrhagic bullae (Fig. 1A), which ruptured to form a gangrenous ulcer with gray-black eschar surrounded by an erythematous halo (Fig. 1B).
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