A 15-month-old infant presented with yellowish papules and nodules scattered on his trunk, back, scalp, and eyelids (Figure 1). The asymptomatic lesions first appeared at three months of age. Since then, they have enlarged and changed from dark red to yellowish-orange. Histological examination of a punch biopsy specimen from the center of a plaque revealed aggregates of histiocytes, Touton giant cells, and lymphocytes in the dermis.

Question

Based on the patient's history and physical examination, which one of the following is the most likely diagnosis?

• A. Cutaneous mastocytosis.

• B. Eruptive xanthomas.

• C. Juvenile xanthogranulomas.

• D. Molluscum contagiosum.

Discussion

The answer is C: juvenile xanthogranulomas. This non-Langerhans cell histiocytosis is associated with asymptomatic, yellowish papules. Lesions appear in infancy or early childhood and often regress by early adolescence. They are usually solitary, but multiple lesions can occur. The most common locations are the head, neck, upper torso, and extremities.