LAUSR

A 23‐month‐old boy presented after 3 weeks for evaluation of an abrupt ulcerative lesion on the right buttock concurring with an acute otitis media. His parents referred an aphthae and fever epi‐ sode the previous week. The patient had no familiar remarkable an‐ tecedents and was born at term from a noncomplicated pregnancy and labor. At the age of 15 months, he had attended our emergency service for a similar ulcerated lesion on the left leg, also in the con‐ text of acute otitis media, presuming the diagnoses of contagious ecthyma. At that time, he was treated with oral amoxicillin‐clavulanic and topical mupirocin with resolution of the lesions. Examination revealed a big, round and well‐circumscribed ulcer‐ ative plaque with central crusting and raised erythematous borders involving the right buttock (Figure 1), in addition, there were numer‐ ous clustered pustular lesions in other different locations such as the right atrial lobe, neck, left forearm, and lower extremities (Figure 2). We soon observed new similar lesions developing in peripheral cath‐ eter insertion areas. A basic blood test revealed leukocytosis with neutrophilia and elevated erythrosedimentation rate, bacterial skin culture of the ulcer were repeatedly negative. A skin biopsy was per‐ formed (Figure 3 and Figure 4).