The Mysterious Case of the Boy who Barked

A 14-year-old with an odd facial rash has vocal outbursts at school, especially when teased and at home when stressed. What’s wrong? Your Dx?

On first impression, the 14-year-old patient appears to have a persistent perioral rash, likely related to lip licking. The reality turns out to be a lot more complicated.Like Dr Jonathan Schneider's other cases, The Boy who Barked illustrates that even when a diagnosis seems obvious, executing the basics, ie, a complete history, including family and psychosocial and behavioral details, and a comprehensive physical examination, may direct your suspicion in another direction. 

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