370.4-year-old boy is brought to the ED by a concerned mother after she
noticed lesions under his nose and around his mouth as seen in the image
below. The patient is otherwise well with no change in behavior, fever, or
vomiting reported. On physical examination, you note a well nourished,
well developed male in no acute distress with multiple small round, honey-
colored lesions with slightly erythematous centers. What is the predomi-
nant organism involved?
400 Emergency Medicine
a. Group B streptococcus
b. Staphylococcus aureus
c. Streptococcus pyogenes
d. Streptococcus pneumoniae
e. Salmonellaspp.
(Reproduced, with permission, from Wolff K, Goldsmith LA, Katz SI et al. Fitzpatrick’s Dermatol-
ogy in General Medicine. 7th ed. New York, NY: McGraw-Hill; 2008: Figure 177-1.)