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

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