Red Book Online Presents: Diagnosis Detective | December 2023
Contributed by Monica Abd El Nour, MD, Pediatric Infectious Diseases, St. Louis Children’s Hospital
A 15-year-old previously healthy male presents with 10 days of right (R) inguinal lymphadenopathy. He also endorses dysuria, but denied fever, rash, URI symptoms or change in mental status.
The physical exam is notable for a palpable 3 cm right inguinal lymph node and an ulcerated skin lesion on the distal right anterior thigh. Ultrasound of the R groin demonstrates enlarged R external iliac and inguinal lymph nodes with surrounding inflammatory changes. Urine Neisseria gonorrhea/Chlamydia trichomatis nucleic acid amplification test (NAAT) is negative.
The patient lives in a suburban setting in Missouri, USA, and engages in outdoor sports. He reports recent tick exposure during sporting events but denies animal exposure or recent travel. The patient denies any sexual activity.
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