Case of the Month

A 5 year old boy presents with a rash on his face OF 3 YEAR’S DURATION!

Diagnosis: MRSA Impetigo with possible Eczema Herpeticum

This 5-year-old boy had this rash on his cheek for 3 years. It developed about the time he moved here from Africa, at age 2. I had seen a case of eczema herpeticum that looked like this when I was a resident. As a result, I started him on Keflex and Valtrex, appropriate for weight, topical Bactroban, and a small dose of Pediapred. I also cultured the cheek for bacteria. 3 days later, the culture came back as MRSA. I called the family and changed the Keflex to Bactrim elixir/solution. He presents today, 14 days into treatment. I may never know if it was just a bad case of impetigo/ecthyma or eczema herpeticum. Never-the-less, after 3 years of a non-healing rash on his face, the parents were thrilled with his progress and happy to show off their super-cute little boy again without embarrassment or having to "field a hundred questions about his face."