Ali is a nine-year-old boy who presents with a one-month history of enlarging, tender swollen areas on his scalp with associated hair loss.

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<p>Ali is a nine-year-old boy who presents with a one-month history of enlarging, tender swollen areas on his scalp with associated hair loss.</p><p>He was treated for suspected cellulitis with oral flucloxacillin two weeks ago, with no effect.</p><p>He is otherwise systemically well with no fever and no past history of note.</p><p>He lives with his parents, two siblings and a pet dog. No other family members are affected.</p><p>On examination, Ali’s vital signs are within normal limits.</p><p>The affected areas on the scalp are tender, oedematous and boggy, with purulent secretions.</p><p>The areas do not fluoresce under Wood’s lamp examination.</p><p>There is associated cervical lymphadenopathy.</p>

Dr Kate Kelso is a GP and medical editor at Australian Doctor.