Dante Pappano, MD

For 3 days, a 6-year-old boy had nonpruritic, painful lesions on the soles of both feet. His mother reported that he had difficulty in sleeping and walking but had no fever or other systemic symptoms.

An otherwise healthy 3-year-old girl was brought for evaluation of fever, sore throat, and shaking chills of 12 hours' duration. She had beefy-red, posterior oropharyngeal erythema and a scarlatiniform rash on her shoulder that had been present for a few hours. The rash faded out over her chest but reappeared in the perineum and lower abdomen. She also had vulvovaginal inflammation with surrounding erythema. The mother was surprised to see the inflammation, but in retrospect added that the child had complained of vaginal discomfort as well. A rapid antigen test for group A b-hemolytic streptococci (GABHS) from a swab of the oropharynx was positive.

The patient was a 6-year-old boy who had Menkes syndrome and bladder diverticula. He was receiving care at home with sterile intermittent catheterization.

Fifteen-year-old girl with several- day history of worsening right-sided facial pain and swelling. Pain severity 10 on a scale of 1 to 10. Limited oral intake.