Case 6: Painful Nodules on Feet of an 11-year-old Boy

1. Benjamin N. Hunter, MD*,† 2. Benjamin R. White, MD, MA† 1. *Division of Otolaryngology - Head and Neck Surgery, Southern Illinois University, Springfield, IL 2. †University of Utah School of Medicine, Salt Lake City, UT A previously healthy 11-year-old boy presents with a 2-day history of severe bilateral plantar foot pain, mild epigastric pain, fatigue, subjective fever, and a 1-day history of a sparse, mildly pruritic, papular-pustular rash over his trunk and extremities. His foot pain has rapidly worsened and prevents him from walking or bearing weight. There is no history of similar symptoms, trauma, or sick contacts or any family history of vasculitides or autoimmune diseases. Two days before the start of the boy’s symptoms, the family returned from vacation in southern California, where he used a community hot tub several times. His mother has developed a similar rash over her trunk and extremities. The patient is well-appearing and afebrile with normal vital signs. He has moderate nonpitting edema of both feet as well as symmetric swelling …