Getting Under A Patient's Skin-Bugs, Bites, and Burrows: A Photo Quiz

July 26, 2013

Creatures of all kinds can get under your patients’ skin and cause problems, and the results sometimes are mistaken for other types of lesions. This week’s photo essay will test your ability to identify various kinds of diagnoses.

Question 1:
A 9-year-old boy had a 1-week history of pruritus and rash on his elbows, knees, back, and legs after running through a field of tall grass. The rash itched and woke him from sleep, and areas of excoriation were noted. The burrow is the classic sign of his condition.

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Question 2:
A 56-year-old woman complained about a cluster of “itchy bumps” on her arms and legs. Every morning, she would awake to see a new set of similar lesions. Bedbugs were found, and the infestation was remediated.

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Question 3:
A 6-year-old boy presented with an erythematous, intensely pruritic “rash” that extended from the foot all the way up the lower leg in a serpentine fashion. He had a recent history of walking barefoot on a beach in south Florida where dogs are allowed.

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Question 4:
An 8-year-old boy presented with an unusual rash on his left forearm after returning from a family vacation in northern California, where he had been bitten by an unknown insect. The site was surrounded by a gradually advancing red margin indicative of erythema migrans, and he tested positive for Lyme disease.

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Question 5:
A 26-year-old woman had 2 extremely pruritic lesions on her upper back that consisted of subtle erythema and edema with a small central vesicle. Ipsilateral axillary adenopathy was absent. She had a new pet kitten. The results of a KOH preparation were negative.

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ANSWER KEY:



Question 1. Answer: d

Question 2. Answer: c

Question 3. Answer: a

Question 4. Answer: b

Question 5. Answer: a