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A 3\m=1/2\-year-old white girl presented with a 6-day history of a rash and fever. The fever resolved after 48 hours, but the rash, which was vesiculobullous and hemorrhagic, had become more extensive. The patient was initially thought to have atypical varicella with secondary bacterial infection and was treated with oral oxacillin sodium and diphenhydramine hydrochloride. She was the product of a normal pregnancy and delivery without previous developmental or medical problems.Results of the physical examination were normal except for the cutaneous findings. There were multiple tense vesicles and bullae filled with clear to hemorrhagic fluid and crusted lesions distributed over the scalp, face, neck, trunk, and all extremities. The vesicles ranged in size from 3 mm to 2 cm and were pruritic, and many were arranged along the borders of erythematous or crusted patches (Fig 1).Biopsy of an intact early vesicular lesion revealed a subepidermal bulla with edema of adjacent papillary dermis and a mild mixed inflammatory infiltrate with eosinophils and neutrophils (Figs 2 and 3).Direct immunofluorescence performed on lesional and perilesional skin revealed a linear deposition of IgA along the dermoepidermal junction, while no staining was noted for IgG, IgM, C3, or C4 (Fig 4).

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