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Chromobacterium violaceum sepsis, a rarely reported phenomenon, has a high mortality rate. We report a unique case of C. violaceum sepsis in an infant. A 4-month-old girl presented to our institution with fever, pustular skin lesions, and distended abdomen, as well as diminished activity and mental status. Radiological investigation revealed brain, lung, and hepatic abscesses. The infant was successfully treated with trimethoprim-sulfamethoxazole and ciprofloxacin.

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ABSTRACT. Paraneoplastic autoimmune multiorgan syndrome, also known as paraneoplastic pemphigus, has been observed only rarely among children. We describe a 10-year-old boy with typical clinical and histologic findings of paraneoplastic pemphigus associated with Castleman's disease. His disease was refractory to resection of the tumor and aggressive combination immunosuppressive therapies. The patient died 1 year after presentation, as a result of complications of bronchiolitis obliterans. This case is unusual because of the young age of the patient. Pediatrics 2004;114:e513-e516. URL: www. pediatrics.org/cgi/doi/10.1542/peds.2004-0436; paraneoplastic pemphigus, paraneoplastic autoimmune multiorgan syndrome, child, Castleman's tumor.ABBREVIATIONS. PAMS, paraneoplastic autoimmune multiorgan syndrome; CT, computed tomography; C3, complement component 3; Ig, immunoglobulin. P araneoplastic autoimmune multiorgan syndrome (PAMS) (paraneoplastic pemphigus) encompasses a multitude of mucocutaneous and systemic findings. Mucocutaneous involvement in paraneoplastic pemphigus is prominent, with painful erosive lesions involving the oral, nasal, upper gastrointestinal, respiratory, ocular, and genital epithelium. 1 Cutaneous manifestations are variable and often consist of polymorphous inflammatory macules, papules, and plaques. Histopathologic examinations classically reveal acantholysis, intraepidermal blister formation, and immunoreactant deposition along the basement membrane and within epithelial intercellular spaces. Associated neoplasia is a requisite finding of PAMS but may be occult at the onset of cutaneous lesions. Patients with PAMS frequently have significant pulmonary involvement, which accounts for the high mortality rate.The occurrence of PAMS in childhood has been reported infrequently. When PAMS occurs among children, however, Castleman's disease is the most common underlying neoplasm, with progressive bronchiolitis obliterans resulting in pulmonary destruction and death. We report the case of a 10-yearold child who developed a diffuse mucocutaneous eruption that was clinically and immunopathologically consistent with PAMS. Systemic evaluation revealed a retroperitoneal Castleman's tumor. CASE REPORTA 10-year-old, previously healthy, white boy presented with a 2-month history of a papular eruption of the trunk, conjunctivitis, erosive stomatitis, proximal nail fold inflammation, and nail dystrophy. Prior evaluation included a positive mycoplasma titer and a skin biopsy that was interpreted as indicating erythema multiforme/Stevens-Johnson syndrome. The mucocutaneous lesions were resistant to systemic corticosteroid treatment. The patient was referred to our institution because of progressive symptoms.System review results included fever, cough for 6 to 8 weeks, fatigue, constipation, and weight loss, with poor food intake attributable to painful oral ulcers. The physical examination revealed a thin boy with perioral cyanosis and resting tachypnea. A facial examination revealed bilateral exudative bulbar a...

Focal application of high-concentration TCA to atrophic and "ice-pick" acne scars appears to produce clinical improvement. Histologic changes of this technique are described.

Nevus lipomatosus cutaneus superficialis (NLCS) is a rare developmental anomaly characterized by isolated ectopic mature adipose tissue in the dermis. We describe a child with a NLCS present from birth that was growing in size. The lesion was removed by simple excision and has not recurred.

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Keloids are more likely to develop when ears are pierced after age 11 than before age 11. This observation holds true for patients with a family history of keloids. Given the difficulty and cost of treating keloids, prevention remains the best approach. Patients with a family history of keloids should consider not having their ears pierced. If this is not an option, then piercing during early childhood, rather than later childhood, may be advisable. Primary care physicians and pediatricians should educate children and their parents about the risk of keloid formation.