A 6-week-old Caucasian male was referred for evaluation of generalized pruritic rash, chronic emesis, and intractable diarrhea. He vomited after every feeding and had 5 to 6 loose stools per day. His symptoms did not improve after switching from cow milk formula to an extensively hydrolyzed formula. The family history obtained on admission was ''negative for history of skin disease/eczema.'' Physical examination showed an irritable infant with generalized erythroderma, severe skin scaling, purulent drainage from an ear canal, and crusted eyelids (Figure 1). His white blood cell count was 9900/mm 3 , hemoglobin 8.3 mg/dL, and platelets 605 000/mm 3 , with 31% neutrophils, 33% lymphocytes, 9% monocytes, and 27% eosinophils. The absolute eosinophil count was elevated at 3753 cells/mm 3 . IgG and IgM were within normal limits, but IgE was elevated to 157 kU/L (normal range < 17). Milk-specific IgE was not detected, but the infant's diet was changed to an amino acid-based formula. Lymphocyte subset profile showed a normal percentage of T and B cells. Mitogen response tests were normal. He was diagnosed with otitis externa and started on intravenous broad-spectrum antibiotics. Eye culture grew methicillin-sensitive Staphylococcus aureus (MSSA), and ear culture grew Pseudomonas aeruginosa. Skin biopsy showed psoriasiform dermatitis.
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