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An Erythematous Papular Lesion on the Neck of a Young Boy

We were asked to evaluate a 10-month-old boy with a 3-day history of a well-defined pink patch on his abdominal skin. His past medical history was significant for complex congenital heart disease that had required hospitalization in the intensive care setting for the majority of his life. More than 1 month before his initial consultation with our service, Candida albicans sepsis had been diagnosed, and he remained on highdose fluconazole. Also, approximately 20 days before this consultation, he had developed persistent fevers for which an extensive microbiologic and radiographic workuphadbeenundertaken,withnegative results.His febrile episodes were being managed with acetaminophen administration and ice pack application. Physical examination revealed a 4 · 4-cm geometric, partially blanchable, erythematous patch without induration or warmth on the right lateral lower abdomen (Fig. 1). There were no other cutaneous lesions and no palpable lymphadenopathy. Upon review of his vital signs, he had been intermittently febrile up to 102.4 F for approximately 3 weeks before consultation. Two 3-mm skin punch biopsies were obtained from the right abdomen patch, one for hematoxylin and eosin stainung (Fig. 2A, B) and one for tissue culture.