The Mysterious Case of the Infant with Red Cheeks

You see a 9-month-old male with acute onset of warm, erythematous cheeks. Immunizations are up-to-date. History is unremarkable.

Non-tender, very erythematous area that shows 2.5 cm of induration on both cheeks.

Erythematous lesions that are warm to the touch on both cheeks.

A partial differential diagnosis: Erythema infectiosum/Fifth’s disease; neonatal lupus; child abuse; panniculitis from something cold; chilblains.

The child has been teething; what has the mother used to assist?

Answer is popsicle panniculitis; a benign, self-limited form of cold panniculitis.

Cold panniculitis: Disorder of subcutaneous fat; a lobular panniculitis characterized by intense inflammation at dermosubcutaneous junction.

There are many types of panniculitis; never assume cold is the answer; systemic diseases such as buccal cellulitis (Haemophilus and Pneumococcal sepsis) can have very similar presentation.

Cold panniculitis caused by a frozen teething ring and by ice chips placed in the mouth.

Panniculitis caused by ice chips used for teething.

Angular cheilitis is another complication of teething rings.

Buccal cellulitis and early orbital cellulitis caused by H. influenzae.