Can you diagnose this 16-month-old with a rash, earache, and fussiness?

Welcome to this Contemporary Pediatrics poll. Take a look at the following case below. After reading through the description, choose a multiple-choice answer and try to guess the correct patient diagnosis.

Then visit our website on Thursday, October 1, 2026, at 12:00 PM EST or later for the full case presentation, differential diagnosis, and correct patient diagnosis.

This case was presented by Carly W. Wilbur, MD, FAAP.

The case:

A 16-month-old in general good health with up-to-date vaccines presents in May with complaints of fussiness and earache. On exam, she is found to have bilateral otitis media and is prescribed Amoxicillin.

One month later, she presents with similar symptoms and is again diagnosed with bilateral otitis media and prescribed Amoxicillin. Mom phoned the office to report a rash on day #2 of the second course of Amoxicillin and added that she learned recently of her maternal grandmother’s Penicillin allergy. Amoxicillin was discontinued, and the patient was switched to Cefdinir to treat the ear infections; Claritin was added to help calm the rash. Photos were sent electronically through the EMR (1). The following day, Mom called the office to report worsening rash. What began at the right hip (overlying a known hemangioma) now extended to the ipsilateral anterior thigh (2). Oral steroids were added to her regimen. The next day, she returned to the office for an in-person evaluation of the rash.

On exam, she had islands of erythematous, lichenified skin with scabs dotting the lesions of different stages and shapes, some looking a bit like target lesions (3) (4). Her ear exam was entirely normal, so the Omnicef was discontinued, as were the oral steroids and antihistamines, which did not appear to have any added value associated with their use. After two days, the patient again returned to the office with concerns for advancement of the rash. At this visit, her skin had pustules sitting amid the erythematous macules (5). There were no vesicles or crusting lesions. There were no complaints of pain or tingling. There was no evidence of itching or excoriation. One lesion was unroofed, and the sample was sent for PCR testing. What is this child’s diagnosis?

Below, take your best guess at diagnosing this patient.