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August 18, 2008

Nodule on the Toe After Traveling to Africa—Quiz Case

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Arch Dermatol. 2008;144(8):1051-1056. doi:10.1001/archderm.144.8.1051-c

A 17-year-old woman without a notable medical history presented with a lesion on the right second toe 2 weeks after returning from Uganda, Africa. During her visit, she worked briefly in a field wearing sandals on her feet. Several days later, a yellow callus developed on the tip of her right second toe. The callus became progressively thicker and brown in the center. She described it as mildly itchy and stingy but denied pain, drainage, or fever. She was not a runner and denied trauma or wearing tight-fitting shoes. On physical examination, the distal end of the patient's right second toe had a thickened yellow nodule that looked like a callus, with a brown center and covered by scant brown dried exudate and multiple tiny, loosely adherent white specks (Figure 1). Microscopic examination of the contents of the lesion are shown in Figure 2.

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