Website maintenance is scheduled for Saturday, October 12, and Sunday, October 13. Short disruptions may occur during these days.

brand logo

Am Fam Physician. 2023;107(4):429-430

Author disclosure: No relevant financial relationships.

A 28-year-old man presented with multiple skin lesions and a painful swollen right ankle. He had first noticed a purulent blister on his right knee about two weeks earlier. This lasted for several days, and then similar skin lesions developed on his left leg, the bilateral palmar surfaces of his hands, and the plantar surfaces of his feet. Right ankle pain also began about two weeks earlier and improved enough to permit partial weight-bearing. The patient had a cough and subjective fevers lasting for 48 hours but no other symptoms, including oral or genital lesions, vision changes, eye pain, pain with urination, or penile discharge. He denied history of sexually transmitted infections or new sexual contacts.

On physical examination, his vital signs were normal. A painful papular lesion with central ulceration was noted on his right knee (Figure 1). Pustules were present on his left palm (Figure 2) and left posterior leg, with tender subcutaneous red nodules on the sole of his left foot. The lesions were 5 to 10 mm in diameter, were nonblanchable, and had no purulence or bleeding. No lesions were noted on his tongue, gums, or soft or hard palate. His right foot was slightly swollen but showed no ecchymosis, erythema, or fluctuance. He had tenderness over the lateral subtalar joint and along the midfoot.

Already a member/subscriber?  Log In

Subscribe

From $165
  • Immediate, unlimited access to all AFP content
  • More than 130 CME credits/year
  • AAFP app access
  • Print delivery available
Subscribe

Issue Access

$59.95
  • Immediate, unlimited access to this issue's content
  • CME credits
  • AAFP app access
  • Print delivery available
Purchase Access:  Learn More

The editors of AFP welcome submissions for Photo Quiz. Guidelines for preparing and submitting a Photo Quiz manuscript can be found in the Authors' Guide at https://www.aafp.org/afp/photoquizinfo. To be considered for publication, submissions must meet these guidelines. Email submissions to afpphoto@aafp.org.

This series is coordinated by John E. Delzell Jr., MD, MSPH, associate medical editor.

A collection of Photo Quiz published in AFP is available at https://www.aafp.org/afp/photoquiz

Continue Reading

More in AFP

More in PubMed

Copyright © 2023 by the American Academy of Family Physicians.

This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP.  See permissions for copyright questions and/or permission requests.