A previously healthy 11-month-old female was seen in the ER for evaluation of an erythematous, somewhat painful papular lesion, diagnosed as impetigo and treated with topical mupirocin. Three days later, she was seen again, now with fever and cellulitis with an abscess on the proximal left thigh. Her temperature was 102.5°F, and the abscess was drained (without culture) and she was sent home, treated with trimethoprim/sulfamethoxazole. Five days later, with ongoing fever and the development of emesis, she returned to the ER, where her temperature was 103.2°F, with a pulse of 185 and tachypnea.

On exam, her left thigh was a bit swollen, and more pus was drained from the abscess (Figure 1), and she was admitted for treatment of possible sepsis. In the hospital, she was also found to have multiple discrete, erythematous, somewhat painful papular lesions, similar to the one on her left thigh earlier. They seemed to be clustered mostly on her right arm and hand (Figures 2 and 3), with a pustule on the hypothenar eminence. The rest of her exam was unremarkable.