Butterfly rash in a young boy: a quiz.

An 11-year-old boy presented in February 2008 with a facial butterfly rash that persisted for at least one month. Lupus erythematosus was repeatedly suspected and the boy was referred for further examinations. A detailed medical history did not reveal any arthralgia, fever, malaise, exanthema, intense exposure to ultraviolet (UV) light in the period one to three weeks before onset of the rash. Physical examination revealed sharply demarcated homogenous erythema on the cheeks, forehead and nose (Fig. 1a) without scaling, but with considerable accentuation of the outer rim (Fig. 1b). Laboratory tests, including complete blood count, rheumatoid factor, antinuclear antibody (ANA) screening, creatinine kinase, erythrocyte sedimentation rate and Creactive protein (CRP), remained negative. Cefuroxime 125 mg twice a day over 10 days led to complete remission without further symptoms.