Editor's Note: The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.
A 2-year-old girl presents to her pediatrician with a 1-week history of a worsening papular rash associated with intense pruritus on the trunk, arms, and hands (see Figure 1 ).
The itching is worse at night. She had not used any oral or topical medications before the onset of pruritus. Her parents deny any history of allergies, concurrent fever, or other illness. Her vaccination schedule is up-to-date. The patient's recent social history includes a summer vacation to the mountains 3 weeks before her parents noticed the skin rash.
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Cite this: A 2-Year-Old Girl With Intense Itching - Medscape - Feb 26, 2015.