An 18‐Month‐Old Child with Ornithine Transcarbamylase Deficiency and a Rash

Case Presentation A healthy, 9-year-old boy presented with a 6-week history of an enlarging, nontender, erythematous plaque in the right periorbital region. It had commenced as a small pink papule near the right lateral canthus after a cat scratch. Previous treatment had included topical mupirocin, several courses of systemic antibiotics, and acyclovir without improvement. The patient had continued to feel well without any fevers or chills, changes in activity level, or ophthalmologic symptoms. Physical examination revealed an indurated, erythematous, slightly crusted plaque at the right periorbital region (Fig. 1). Several small, nontender, mobile, subcutaneous nodules were palpated radially along the right cheek. A skin biopsy specimen was obtained for histopathological evaluation (Figs. 2 and 3) and tissue culture.