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Correspondence |

Diffuse Umbilicated Vesicles in a Critically Ill Child

Laura Chang, MD; David Cassarino, MD, PhD; Valentina Sosa, MD
JAMA Dermatol. 2013;149(5):641-642. doi:10.1001/jamadermatol.2013.2512.
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Extract

Methicillin-resistant Staphylococcus aureus (MRSA) septicemia can produce disseminated skin lesions, but a vesicular eruption is not a well-recognized presentation of this infection.

Correspondence: Dr Chang, Department of Dermatology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA 90027 (Laura.S.Chang@kp.org).

Conflict of Interest Disclosures: None reported.

Additional Contributions: We appreciate the help of Evan Steinberg, MD, from the Infectious Disease Department, and Kianoush Shakib, MD, Sandy Jung-Wu, MD, and Bruce Goldberg, MD, from the Allergy/Immunology Department of our institution.

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Figure 1. Multiple umbilicated vesicles with an erythematous base developed in a 10-year-old boy with septic shock.

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Figure 2. Histopathologic images from our case. A, Vesicle shows a dense neutrophilic infiltrate, epidermal necrosis, and a subepidermal bullous cavity (hematoxylin-eosin, original magnification ×40). B and C, Gram staining shows numerous gram-positive cocci in clusters in the bullous cavity and neutrophilic infiltrate (original magnification ×60 [B] and ×100 [C]).

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