An Unexplained Lesion on the Leg of a 2-year-old Girl

1. Talia Greenspoon, MD, FRCPC* 2. Miriam Weinstein, MD, FRCPC* 1. *Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada An otherwise healthy 2-year-old girl is referred to our clinic for assessment of a lesion on the right lower leg. After a trip to Mexico 15 months prior, the parents first noticed what they describe as a “tan” on the posterior aspect of her right lower leg, followed by a scaly round plaque that would come and go. There has been no pain or pruritus. She was prescribed mometasone furoate ointment, which had some benefit. She later developed red-to-purple nodules in the same area. The patient was seen by multiple providers and was prescribed a combined fusidic acid (antibiotic) and hydrocortisone 1% ointment, a 1-week course of oral cephalexin, and betamethasone valerate 0.05% ointment; each without any improvement. The patient lives in a house in an urban area. She has not had contact with any animals. There are no noted exposures to insect bites or changes in clothing or detergents. The family history is noncontributory. On physical examination, the patient appears healthy. On the right leg, there are multiple violaceous coalescent plaques with overlying erythematous papules with scale (Fig 1) with no drainage or edema. The skin is otherwise smooth and clear. There are small, mobile lymph nodes palpable in the right inguinal canal. Findings on the rest of the physical examination are normal, including range of motion of the ankles, knees, and hips …