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JAMA Clinical Challenge

Sudden Purpuriform Rash in an Infant

Image of  A, Erythematous swelling of ears and right eyelid and erythematous perioral macules at presentation. B, Large erythematous plaques on the face 4 days after presentation. C, Purpuric lesions in targetoid pattern on lower limbs

Helene Sophie Scheer
Lisa Weibel, MD
A 10-month-old boy presents with erythematous swelling of bothears and right eyelid and erythematous perioral macules following a respiratory tract infection 12 days before presentation (Figure, A). Within 4 days the lesions increased in size, becoming large erythematous plaques on the face (Figure, B). Targetoid, purpuric lesions developed on the limbs (Figure, C), along with hand edema. There were no trunk lesions and no involvement of the mucous membranes. The child is otherwise in good general health. On examination he is afebrile, has normal vital signs, and there is no lymphadenopathy or organomegaly. Findings from urinalysis, complete blood cell count, coagulation studies, and liver and kidney function studies are unremarkable.

See the full article for an explanation and discussion.

Author Affiliations: Dr Weibel (lisa.weibel@kispi.uzh.ch) and Ms Scheer are affiliated with the Department of Dermatology, University Children's Hospital Zurich (Ms Scheer and Dr Weibel); and Department of Dermatology, University Hospital Zurich (Dr Weibel), Zurich, Switzerland.