An ill-appearing 12-year-old boy was hospitalized in April with a 4-day history of fever, severe headaches, neck pain, photophobia, and malaise. There were 40 to 50 erythematous papules and vesicles scattered on his face, torso, and extremities (Fig. 1) and two tender 2- by 1-cm inflammatory nodules with necrotic eschars on his back (Fig. 2). No enanthem or regional lymphadenopathy were noted. Routine bacterial and viral cultures of cerebral spinal fluid (CSF), blood, and one of the necrotic skin lesions on the back were negative. Polymerase chain reaction of CSF and skin for herpes simplex virus and varicella-zoster virus were also negative. A biopsy of one of the ulceronecrotic nodules on his back was obtained, which showed a focal epidermal ulceration associated with ballooning degeneration of keratinocytes, necrosis of the epidermis, and a mixed band-like predominantly lympho-histiocytic inflammatory infiltrate adjacent to the epidermis in addition to superficial and deep perivas-cular lymphohistiocytic inflammation.
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机译：一名体重较轻的12岁男孩于4月份住院，发烧，严重头痛，颈部疼痛，畏光和全身不适的病史为4天。在他的脸，躯干和四肢上散布着40至50个红斑丘疹和囊泡（图1），以及两个柔软的2 x 1 cm炎症结节，背部有坏死性焦char（图2）。未观察到前药或局部淋巴结肿大。常规的脑脊髓液（CSF），血液和背部坏死性皮肤病灶之一的细菌和病毒培养均为阴性。脑脊液和皮肤的聚合酶链反应对单纯疱疹病毒和水痘带状疱疹病毒也呈阴性。对他背部的一个溃疡坏死性结节进行了活检，显示出局灶性表皮溃疡，与角化细胞的气球状增生，表皮坏死以及与表皮相邻的混合性带状主要是淋巴组织炎性炎症浸润有关。浅表和深层血管周围淋巴细胞组织细胞炎症。
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