Visual Diagnosis

Abstract

1. Laurene M. Fleischer, MD* 2. Rosa Cataldo, DO* 3. Salma S. Syed, DO* 1. *Department of Pediatrics, State University of New York, Stony Brook, NY A 10-year-old boy presents with the chief complaint of an itchy rash of his left foot. The pruritic area, localized to the plantar surface, began 2 weeks ago, with symptoms progressively worsening. One week ago, the boy noticed a small raised lesion over the itchy area. Over the next few days, the lesion increased in size and started to look like “a squiggly line.” Various preparations, such as topical hydrocortisone, calamine lotion, antifungal spray, and oral antihistamines, failed to provide relief. His mother denies any change in laundry detergent, soaps, or lotions. He has no fever, weight loss, nausea, vomiting, diarrhea, cough, or chronic or severe illnesses. His immunizations are up to date, and he takes no medications other than those mentioned. The family spent a recent vacation in Cancun, Mexico, where the children played in a sand box and swam in the ocean. On additional questioning, the family recalls seeing feral cats in the same sandbox. Physical examination reveals a well-nourished, well-appearing boy. His temperature is 98.4°F (36.9°C), pulse is 81 beats/min, respiratory rate is 20 breaths/min, and blood pressure is 125/64 mm Hg. His head and neck examinations reveal no findings of interest. His heart sounds are normal; there are no murmurs, rubs, or gallops. His lungs are clear to auscultation without wheezing, rales, or rhonchi. His abdomen is soft, nondistended, and nontender. There is no lymphadenopathy. On the plantar surface of his left foot is a 3.5-cm raised, nontender, erythematous, serpiginous lesion (Fig. 1). There is no drainage from the area, interdigital rash, or excoriation. There are no other skin manifestations. Figure 1. A 3.5-cm …