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- Melissa Cossey, MD*
- Allison Hsu, MD†
- Luis Seguias, MD†
- *UT Southwestern Medical Center, Austin, TX.
- †University of Texas Southwestern Medical Center, Dallas, TX.
AUTHOR DISCLOSURE
Drs Cossey, Hsu, and Seguias have disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.
Dr Cossey's current affiliation is Dell Medical School at University of Texas at Austin, Austin, TX.
Presentation
A previously healthy, 8-year-old, Hispanic boy presents to the emergency department with a recurrent rash on his right posterior thigh. The patient’s mother says that the involved area always becomes “infected” whenever the patient develops a fever, with this being the third and most severe episode. His mother reports that the rash was first noticed 2 years ago when the family was still living in Mexico. At that time, it appeared to be an insect bite that was associated with redness and itching, and his mother empirically applied a topical antibiotic to the lesion. Within a week, the bite resolved, but the patient was left with a small, darkly discolored area in its place.
One year ago, the patient had an episode of fever associated with diarrhea. Simultaneously, the lesion on the patient’s right posterior thigh again became red and itchy, so his mother applied a topical antibiotic to the area. After resolution of that acute illness, the redness improved, but he was left with an even larger dark discoloration at the site.
The current episode began 5 days ago with fever, mild runny nose, headache, and sore throat. The following day, the area on his right posterior thigh again developed redness and itching and started to blister. His mother brought him to the emergency department on the third day of illness, where he was diagnosed as having cellulitis and prescribed oral trimethoprim-sulfamethoxazole. His mother now reports resolution of his fever, sore throat, and headache but continued worsening of the rash despite the …
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