Visual Diagnosis: Swelling and Redness of the Fourth Toe in a 3-month-old Infant

Abstract

1. Charles O. Onyeama, MD*† 2. Karla Vitale, DO*† 3. Kenneth Cochran, MD*† 4. Ginikanwa L. Onyeama† 1. *Cibola Family Health Center, Grants, NM. 2. †Cibola General Hospital, Grants, NM. A 3-month-old boy presents to the emergency department (ED) with a history of fussiness and inconsolable crying throughout most of the day. His mother states that there is no identifiable cause for his discomfort. He is tolerating feeding and does not have any signs of illness, including cough, nasal congestion, fever, or change in stool pattern. As the day has progressed, the infant's fussiness has subsided, but he has developed purplish discoloration and swelling of the fourth right toe. The mother is concerned that something is constricting the toe and has attempted to find the cause but cannot, which has prompted the visit to the ED. The infant was born at term after an uneventful pregnancy. He has remained in good health, receiving appropriate immunizations at birth and at 2 months of age. He was circumcised at birth, has never been hospitalized, and has not undergone any other surgical procedure. He is not taking any medication and has no history of allergies. He is the younger of two children. There are no findings of note in the family history. On physical examination, the infant's vital signs …