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JAMA Pediatrics Clinical Challenge
November 2015

Isolated Pustular Nodule on the Thumb

Author Affiliations
  • 1Division of Dermatology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
  • 2Department of Pediatrics, Group Health Associates, Cincinnati, Ohio
JAMA Pediatr. 2015;169(11):1061-1062. doi:10.1001/jamapediatrics.2015.1301

A healthy young girl presented in June 2014 with a 4-week history of a painless, enlarging lesion on her right thumb that started as a small erythematous blister. She reported recently injuring her hand on a metal fence at home and biting her nails frequently. She lives on a farm in Ohio and has extensive direct contact with sheep and cows; family pets include a cat, a dog, and a hamster. There was no known recent travel or contact with anyone with a similar lesion. She reported mild tender lymphadenopathy of the right axilla but denied fever.