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123 Disseminated Erythematous Papules and Pustules: A Quiz Yasuyuki FUJITA 1 , Chihiro SHIIYA 1 , Yuka INAMURA-TAKASHIMA 1 , Toshifumi NOMURA 1 , Akihiko SHIBAKI 2 and Hiroshi SHIMIZU 1 1 Department of Dermatology, Hokkaido University Graduate School of Medicine, N15 W7, Kita-ku, Sapporo 060-8638, and 2 Shibaki Dermato- logy Clinic, Sapporo, Japan. E-mail: [email protected] A 10-month-old Japanese girl presented with asympto­ matic papules on the whole body that had appeared 3 weeks prior to referral. She had been treated with topical corticosteroids and oral antibiotics at a previous clinic, with poor response. Physical examination revealed light- red papules of up to 8 mm diameter scattered over her extremities and head (Fig. 1A, B). Pustules with partly follicular distribution were also observed on her forehead and anterior scalp (Fig. 1B). History-taking revealed that she had received the Bacillus Calmette–Guérin (BCG) vaccine 2 months prior to onset of symptoms. She had no systemic symptoms, such as fever, cough or hepatospleno- megaly, nor did she have episodes associated with immu- nodeficiency. A skin biopsy from a papule on her forearm revealed interstitial and perifollicular lymphohistiocytic infiltration (Fig. 1C). Multi-nucleolar histiocytes were also observed (Fig. 1D). These cells stained positively for CD68 and were negative for S-100 and CD1a. No bacil- lary organisms were detected from the skin specimen by Ziehl-Neelsen staining. What is your diagnosis? See the next page for answer. Fig. 1. (A) Infiltrated light-red papules disseminated on the upper arms. (B) Follicular papules on the forehead and anterior scalp. (C) Histopathological revealing interstitial and perifollicular lymphohistiocytic infiltration (original magnification ×40). (D) Interstitial histiocytic infiltration with multi-nucleolar cells (original magnification ×200). C and D: Haematoxilin and eosin staining. QUIZ SECTION This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta Journal Compilation © 2019 Acta Dermato-Venereologica. doi: 10.2340/00015555-3024 Acta Derm Venereol 2019; 99: 123–124