Acta Dermato-Venereologica 2018, No. 6 98-6CompleteContent | Page 22

QUIZ SECTION Yellow-brown Papules on the Cheeks and Limbs of a Male Infant: A Quiz Julia K. WINKLER 1 , Susanne HANNER 1 , Arno RÜTTEN 2 , Alexander H. ENK 1 , Holger HAENSSLE 1 and Ferdinand TOBERER 1 1 Department of Dermatology, Venerology and Allergology, University Medical Center, Ruprecht-Karls-University, Im Neuenheimer Feld 440, DE- 69120 Heidelberg, and 2 Dermatopathology Friedrichshafen, Friedrichshafen, Germany. E-mail: [email protected] An otherwise healthy 10-month-old male infant presented with a 2-month history of slightly itchy yellow-brownish papules, which were most evident on his cheeks (Fig. 1a). Examination revealed further papules on his arms (Fig. 1b) and trunk. His family history was inconspicuous. Blood tests, including full blood count, liver-function, kidney- function and C-reactive protein level, were within normal limits. Hepatitis B and Epstein–Barr virus (EBV) serology were negative. Topical steroid and antibiotic therapy had no clinical benefit. Due to persistent papules a lesion on the arm was biopsied 2 months later. Histopathology revealed a dermal infiltrate of non-epidermotropic histiocytes ad- mixed with some lymphocytes (Fig. 2a). Histiocytes stained positive for CD68 (Fig. 2b) and S100 (Fig. 2c) and lacked expression of CD1a and langerin (CD207). Proliferative activity (Ki67) was low. What is your diagnosis? See next page for answer. Fig. 1. (a) Multiple yellow-brownish papules on the cheeks. (b) Papules distributed on the arms and single papules localized on the trunk. 620 Fig. 2. (a) Section of a cutaneous papule from the upper arm revealing orthokeratosis, a normal epithelium and many dermal histiocytes admixed with some lymphocytes (haematoxylin-eosin stain, original magnification ×100). Immunohistochemical stain for: (b) CD68 and (c) S100 (original magnification ×100). doi: 10.2340/00015555-2907 Acta Derm Venereol 2018; 98: 620–621 This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta Journal Compilation © 2018 Acta Dermato-Venereologica.