Visual Diagnosis: A Boy with a Fever and a Swollen, Blistering Finger.

Abstract

1. Mark Oliver Tessaro, BSc, MDCM, FRCPC* 1. *Hospital for Sick Children, Toronto, Ontario, Canada. A 7-month-old boy is brought by his parents to the emergency department with a 4-day history of fever, rhinorrhea, and mild diarrhea. Today his parents noted a blister over 1 of his distal right fingers. He has no significant past medical history and no history of allergies. His immunizations are up to date and he has no history of travel. There are no known sick contacts and no pets in the home. He is not taking any regular medications but has been receiving acetaminophen occasionally during the current illness. He has had a slight decrease in appetite, but he is taking his regular amount of fluids and his urine output has not decreased. His stool frequency has not changed, but his stool has become slightly loose during the current illness. There is no history of cough, rash, or swollen joints. On physical examination, the well-appearing boy has an axillary temperature of 37.6°C (99.7°F), heart rate of 152 beats per minute, respiratory rate of 20 breaths per minute, and blood pressure of 105/palpable mm Hg. He is well hydrated and the only finding of note is his right fourth finger, which is moderately swollen, erythematous, and tender. A 0.5 × 1-cm tense bulla with purplish contents extends over the volar surface of the distal phalanx (Figure). Figure. Swollen right fourth finger with a …