Intended for healthcare professionals

Endgames Spot Diagnosis

An extensive perioral rash

BMJ 2019; 366 doi: (Published 19 September 2019) Cite this as: BMJ 2019;366:l5014
  1. Nicholas Beng-Hui Ng, paediatric registrar,
  2. Wee-Song Yeo, consultant paediatric nephrologist
  1. Department of Paediatrics, Khoo Teck Puat–National University Children’s Medical Institute, Singapore
  1. Correspondence to N B-H Ng nicholas_bh_ng{at}

A 15 year old girl presented with a painful rash around her mouth. It started as a small blister at the corner of her right lip and progressed within 48 hours to the appearance seen in fig 1. She also had several painful ulcers on the buccal mucosa. At presentation she had low grade pyrexia of 38°C. The ulcers prevented her from eating solids but she was able to tolerate fluids.

Fig 1

Perioral rash

Further history revealed that she was diagnosed with nephrotic syndrome six years earlier, and had experienced multiple relapses. In accordance with local nephrotic syndrome protocols, she had required …

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