|
Painful Nodules on the Feet
Philadelphia College of Osteopathic Medicine / Lehigh Valley Hospital
Philadelphia, PA
August, 2002
Presenters:
Kenneth T. Kircher, DO (Resident)
Program Director: Stephen Purcell, DO
Clinical Presentation
Patient: 12 years old White Female
History
Chief Complaint: Painful Nodules on Plantar Aspects of
Feet
Signs and symptoms: The patient states that she awoke two
days ago with 1-2 slightly raised erythematous nodules on her right
foot, that were very tender to walk on. By that afternoon, she had 4-6
lesions on the plantar and lateral sides of both feet. They had become
increasingly tender and now prevent ambulation. She denies fever, chills
or other constitutional symptoms. She denies exposure to cold, new
medications, any recent illness or trauma although she did have a
prolonged ballet recital the day before.
Previous Treatment: None
 Physical Exam
Well appearing 12 year old girl with exquisitely tender erythematous
dermal to subcutaneous nodules on the plantar and lateral aspects of
both feet. The rest of her complete cutaneous exam is without other
lesions. Pertinent negatives include lack of: adenopathy, oral or
genital lesions or dermatographism.
Laboratory Tests
CBC
WBC – 14.2 x 109/L, other indices WNL
Dermatohistopathology
Microscopic description:
Pathology Figure #1. There is a prominent peri-eccrine neutrophilic infiltrate; lymphocytes and a rare eosinophil
are also seen. The infiltrate extends to the surrounding tissue but
frank abscess formation is not seen. The dermal ductal portion of the
eccrine gland is not involved. There is no evidence of syringosquamous
metaplasia. There is a mild deep dermal perivascular infiltrate of
neutrophils, lymphocytes and histiocytes. There is no evidence of
leukocytoclastic vasculitis. Fungal and bacterial stains are negative.
(Pathology Figure #1 - pathology pictures are being referenced in
the bibliography.)
Pathology Figure#2. Immunostaining demonstrates the eccrine glands
within the infiltrate.
(Pathology Figure #2- pathology pictures are
being referenced in
the bibliography.)
Differential Diagnosis
|
