LAUSR

A 1 1⁄2-year-old boy presented with a 3-week history of slowly progressive erythematous, pruritic lesions on the upper and lower extremities followed by involvement of the face, trunk, palms, and soles. There was no history of fever, sore throat, and other symptoms suggestive of infections, or medication use prior to the onset of his rash. The vaccination history included first dose of MMR (measles-mumps-rubella), oral polio vaccine (OPV), and varicella vaccine at age 1 year (6 months prior to the onset of his rash). Birth history was unremarkable and development was normal. Family history was non-contributory. On examination, he was afebrile and had no hepatosplenomegaly or lymphadenopathy. He was observed to have multiple erythematous annular plaques with mild hyperpigmentation in the center, and erythematous papules scattered on the trunk, buttocks, extremities (Figures 1 and 2), face, palms, and soles. There were two small erythematous macules on the right buccal mucosa. A punch biopsy was taken from a lesion on the back and histopathology is shown in Figures 3 and 4 (H&E 10 and 20 , respectively).