Milton Fowler, MD

A 10-year-old boy injured his left elbow during football practice. He subsequently had pain with normal range of motion of the elbow.

For the past few weeks, a 10-year-old boy had a pruritic abdominal rash that had not responded to over-the-counter topical medications. The rash had appeared around the time he started wearing a new belt (shown). The child was otherwise healthy. There was a family history of asthma.

Results of a complete blood cell count (CBC), measurements of electrolyte concentrations, and urinalysis were normal. A rapid streptococcal test result was negative. The C-reactive protein level was elevated at 3.3 mg/L (normal, less than 1 mg/L); the erythrocyte sedimentation rate was 58 mm/h (normal, 4 to 20 mm/h).

Multiple tender flaccid bullae (about 2 mm to 2 cm) were present on the perineum. There was no associated discharge. The ruptured blisters had marked erythema in the center and a scaly rim at the periphery. The Nikolsky sign could not be elicited. The infant was afebrile. The remainder of the examination findings were normal.

Three-year-old boy limping on right foot after an unwitnessed fall from trampoline the day before. Pain controlled with ibuprofen. No history of chronic diseases or routine medication use.