Case History/Examination
A 2-month-old female developed three episodes of severe eczematous dermatitis with impetiginization, herpetic infection, and Staphylococcal osteomyelitis requiring multiple hospitalizations over a six-month period. Newborn screening for severe combined immunodeficiency was negative, no history of abnormal bleeding, chronic diarrhea, failure to thrive, and no known family history of atopy or immunodeficiency syndromes. Significant cutaneous erythema and dry excoriation were seen on the forehead, hairline, cheeks (Figure 1), chest, abdomen, bilateral forearms, and ankles. No honey-crusting or vesicular lesions were noted. Neurology and other exams did not reveal significant findings. She had achieved all development milestones on time.