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Male Patient with Tender Pustular Eruption on Lower Extremities

Can you diagnose this case?

David L. Kaplan, MD – Series Editor

Signs and Symptoms

This patient returned to Kansas City from Florida with a 2-day history of this tender pustular eruption on both lower extremities.

How would you diagnose these pustules?

Choose one to reveal diagnosis and discussion

Staphylococcal folliculitis
Gram-negative bacterial folliculitis
Shaving folliculitis
Fire ant bites
Flea bites

ANSWER: Fire ant bites

See the full case at Consultant360

This patient sustained bites from fire ants, which are indigenous to the US Southeast, including Florida, to where he had recently traveled. The bites, which are painful, within 24 hours will produce sterile pustules that can be tender, pruritic, or both. Treatment is symptomatic. Some patients may develop systemic symptoms. The best treatment is prevention by wearing appropriate footwear in endemic regions and being aware of one’s surroundings. The clinical clue here that argues against folliculitis is that the pustules are not folliculocentric.

David L. Kaplan, MD, is a clinical assistant professor of dermatology at the University of Missouri–Kansas City School of Medicine in Kansas City, Missouri, and at the University of Kansas School of Medicine in Kansas City, Kansas. He practices adult and pediatric dermatology in Overland Park, Kansas.