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DIagnosis Detective - December 2024

December 2, 2024

Diagnosis Detective: Can you solve it?
Red Book Online Presents: Diagnosis Detective | December 2024

Editor: Kristina A. Bryant, MD, FAAP

Case contributed by Kevin Tran, DO, Valley Children's Healthcare, Madera, CA

A 5-year-old girl is evaluated for progressive skin lesions on her right arm. Three weeks earlier, she scraped her leg while camping in the mountains of the Sierra Vistas, California. Initially, a small erythematous nodule appeared at the site of the scrape. Over the next few weeks, several more bumps developed along her calf in a line towards the side of her knee, while the first lesion ulcerated and drained clear fluid. She had no fever or systemic symptoms. She was treated with topical mupirocin, cephalexin, and clindamycin, all of which failed to provide relief. The family lives in a rural area in the Central Valley of California and has not traveled outside the state; the child often plays outdoors. On examination, there is non-tender 3 x 2.5 cm ulcer with irregular borders and undermined edges over the lateral aspect of the right calf. There are multiple ulcers of similar size located in a line towards the knee. Mildly enlarged lymph nodes are palpable in the right inguinal canal without warmth, tenderness, or fluctuance.

© 2024 American Academy of Pediatrics. All rights reserved.


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