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American Academy of Pediatrics
Visual Diagnosis

Recalcitrant Rash in a 7-month-old Infant

Jennifer L. Thompson, Thomas B. Russell, George C. Koberlein and Leslie M. Cristiano
Pediatrics in Review February 2021, 42 (2) e5-e8; DOI: https://doi.org/10.1542/pir.2019-0151
Jennifer L. Thompson
*Department of Pulmonology, Critical Care, Allergy, and Immunologic Diseases,
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Thomas B. Russell
†Department of Pediatric Hematology and Oncology,
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George C. Koberlein
‡Department of Radiology, Wake Forest Baptist Hospital, Winston-Salem, NC
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Leslie M. Cristiano
*Department of Pulmonology, Critical Care, Allergy, and Immunologic Diseases,
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  1. Jennifer L. Thompson, MD*
  2. Thomas B. Russell, MD†
  3. George C. Koberlein, MD‡
  4. Leslie M. Cristiano, MD*
  1. *Department of Pulmonology, Critical Care, Allergy, and Immunologic Diseases,
  2. †Department of Pediatric Hematology and Oncology,
  3. ‡Department of Radiology, Wake Forest Baptist Hospital, Winston-Salem, NC

Presentation

A 7-month-old boy presents to the allergy, asthma, and immunology clinic with a medical history significant for slow weight gain in the newborn period, recurrent thrush, and a brief hospitalization for a viral respiratory illness at 3 months of age. He was referred from his primary care provider due to concerns of a rash that has not improved despite a variety of treatments.

The rash first appeared at approximately 2 months of age, and although it has waxed and waned over the previous 5 months, it never completely resolves. While hospitalized for his respiratory illness at 3 months of age, a scabies prep of the rash was performed, but the result was inconclusive. The rash has been treated with permethrin on 2 separate occasions due to concern for scabies, along with topical corticosteroids for eczema and oral antifungals and antibiotics due to concern for fungal and bacterial infections. Despite these treatments there has been no significant improvement in the rash, and it has continued to spread throughout his inguinal area, trunk, face, and scalp.

On physical examination he is a pleasant infant, but throughout the encounter he scratches at the various lesions on his body. His scalp has thick greasy yellow plaques with significant inflammation (Fig 1), and he has reddish-brown lesions on his trunk with severely erythematous areas of denuded skin in his inguinal folds and neck. He has a thick white exudate occluding visualization of his left tympanic membrane. There is an irregularly shaped hard mass measuring approximately 1.5 cm behind his lower 2 front teeth (Fig 2), and white plaques on his gums. …

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Pediatrics in Review: 42 (2)
Pediatrics in Review
Vol. 42, Issue 2
1 Feb 2021
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Recalcitrant Rash in a 7-month-old Infant
Jennifer L. Thompson, Thomas B. Russell, George C. Koberlein, Leslie M. Cristiano
Pediatrics in Review Feb 2021, 42 (2) e5-e8; DOI: 10.1542/pir.2019-0151

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Recalcitrant Rash in a 7-month-old Infant
Jennifer L. Thompson, Thomas B. Russell, George C. Koberlein, Leslie M. Cristiano
Pediatrics in Review Feb 2021, 42 (2) e5-e8; DOI: 10.1542/pir.2019-0151
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