A 21-year-old college student presents for evaluation of an intensely pruritic eruption on the ankle and sole of his right foot. The patient recently returned from a trip to Puerto Rico. He noticed the lesions approximately 1 week after his return. He has no significant past medical history. On physical examination, the patient is in overall good health. Notable findings include 3 red, serpiginous lesions on the heel (Figure, A), lateral area of the midfoot (Figure, B), and ankle, some with vesicles. Vesicles were also noted over the Achilles tendon.
Wieder S, Levitt J. Intensely Pruritic Eruption in a College Student. JAMA. 2014;312(14):1458-1459. doi:10.1001/jama.2014.7086