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Off-Center Fold
September 2007

Tender Nodules on the Palms and Soles—Quiz Case

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Arch Dermatol. 2007;143(9):1201-1206. doi:10.1001/archderm.143.9.1201-d

A 10-year-old white boy presented with a 3-day history of painful, red, swollen hands. Physical examination revealed multiple, erythematous, 1- to 3-cm, tender nodules on his palms (Figure 1). A few similar smaller nodules were present on the plantar aspect of the middle of both heels. The patient had an associated low-grade fever but was otherwise healthy and active. He had recently spent a lot of time in ice hockey practice. His primary care physician had initially evaluated him, and the results of rapid streptococcal screening were negative, no murmur was appreciated, and no treatment had been initiated. A 4-mm punch biopsy specimen was obtained from a palmar lesion for microscopic evaluation (Figure 2 and Figure 3).

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