A 6-year-old girl with painful rash on her left lower extremity.

A6-year-old girl presented to our outpatient department with complaint of a painful rash on her left lower extremity for the past 4 days. The rash had started as vesicles and blisters on her left buttock. Over the next few days, new painful lesions erupted on her left thigh, leg, ankle, and foot. The child was febrile (a temperature of 100 ̊F) and irritable, but otherwise well and alert. Her body weight was 21 kg. Her vaccination history was standard and up-to-date. She was normal for her developmental milestones and there was no history of any major illness. Family history was non-significant. Systems examination was normal. On cutaneous examination, several coalescing vesicles and blisters were present on the left side of her external genitalia (Figure 1A), on her left buttock, on her posterior thigh, leg, ankle, and on the dorsum of her foot (Figures 1B and 1C). There were no other skin or mucosal lesions. Left inguinal lymph nodes were enlarged and tender. A Tzanck smear was prepared from one of the vesicles, which revealed presence of multinucleated giant cells (Figure 2). A 6-Year-Old Girl with Painful Rash on her Left Lower Extremity