Contagious Skin Lesions in Three Pediatric Patients: From Initial Presentation to Differential Diagnosis

Case at a Glance

Three female pediatric patients in close contact developed sequential skin lesions initially mistaken for insect bites, progressing to open sores in the youngest patient. All patients experienced concurrent gastrointestinal symptoms.

Patient's Story

Patient A (18-month-old female, 20 lbs, 32 inches) was the index case, presenting with multiple red lesions on bilateral lower extremities and face, with predominant involvement of the legs. The lesions were initially attributed to infected mosquito bites due to presumed scratching. Over several days, the lesions progressed to open, weeping sores that appeared to worsen. Patient B (3-year-old female, 44 lbs, 42 inches) subsequently developed similar lesions on the shoulder and knee. Patient C (4-year-old female, 39 lbs, 43 inches) developed comparable lesions that remained erythematous and papular without ulceration. All three patients experienced at least one episode of diarrhea during the same timeframe.

Initial Assessment

The caregiver initially suspected insect bite reactions with secondary bacterial infection in the index patient. For the second patient, ringworm was considered, prompting empirical treatment with topical antifungal medication. The sequential nature of the presentations and close contact between patients suggested a contagious etiology.

The Diagnostic Journey

The progression from Patient A to Patients B and C over several days, combined with the morphology of the lesions and their distribution, raised suspicion for a bacterial skin infection. The consulting physician noted the contagious pattern and questioned vaccination status to broaden the differential diagnosis beyond the initially suspected impetigo.

Final Diagnosis

Clinical presentation highly suggestive of impetigo, pending formal medical evaluation and possible bacterial culture confirmation.

Treatment Plan

Urgent pediatric consultation scheduled. Consideration for topical or systemic antibiotic therapy pending clinical assessment. Isolation precautions recommended until bacterial etiology confirmed and appropriate treatment initiated.

Outcome and Follow-up

Patients scheduled for immediate medical evaluation the following day. Close monitoring of lesion progression and systemic symptoms recommended. Contact precautions advised for all household members and close contacts until infectious etiology ruled out or adequately treated.