This 10-year-old boy had an intermittent fever, headache, and stomachache for 2 weeks before developing red cheeks and ears. On the following day red patches blossomed on his arms, legs, neck, and chest which became blistered within hours. Erosions spread throughout his mouth and conjunctivae, and he was admitted to the pediatric intensive care unit for management of fluids, pain, and possible infection. Lesions progressed for a week, and on day 4 he received intravenous immumoglobulin. He required a central line for fluid resuscitation, fentanyl for pain, and a urinary catheter. He was discharged home on day 15 and developed desquamation of the palms and soles 2 days later. Fortunately he recovered without serious complications. Nails shed 2 months later, and mottled pigmentation persisted.
day 1-intact 0.2-1.0 cm vesicles and bullae on red base