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Special Feature |

Picture of the Month—Quiz Case FREE

Marta Ferran, MD; Gemma Martin-Ezquerra, MD; Asunción Vicente, MD; Antoni Noguera, PhD; Laia Alsina, MD; M. Antonia Gonzalez-Enseñat, MD
[+] Author Affiliations

Section Editor: Albert C. Yan, MD
Assistant Section Editor: Samir S. Shah, MD


Arch Pediatr Adolesc Med. 2007;161(2):199. doi:10.1001/archpedi.161.2.199.
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Published online

A 16-year-old boy with a medical history of mild developmental delay was evaluated for several asymptomatic lesions that appeared progressively on his palms and soles during the last month. There was no associated fever, malaise, lethargy, headache, or arthralgia.

Physical examination revealed several red papules with hyperkeratotic surfaces, 5 to 16 mm in diameter, located on both palms and soles without crossing the palmar creases (Figure 1). Some isolated lesions were noted on his wrists and ankles. Thorough examination revealed a subtle, nonpruritic, reddish macular eruption distributed symmetrically on his trunk and extremities (Figure 2). Superficial painless lesions on the penis were also noted, as well as annular erythematous papules on the lateral aspects of his tongue (Figure 3). There was no visceromegaly, but generalized, nontender lymphadenopathy was present.

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Figure 1.

Red papules with hyperkeratotic surface had developed on the patient's palms (A) and soles, including the inner aspect of his feet (B), during the last month.

Graphic Jump Location

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Figure 2.

An asymptomatic reddish macular eruption on the patient's trunk was detected during physical examination.

Graphic Jump Location

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Figure 3.

Annular erythematous papules were present on the lateral aspects of the patient's tongue.

Graphic Jump Location

Figures

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Figure 1.

Red papules with hyperkeratotic surface had developed on the patient's palms (A) and soles, including the inner aspect of his feet (B), during the last month.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.

An asymptomatic reddish macular eruption on the patient's trunk was detected during physical examination.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 3.

Annular erythematous papules were present on the lateral aspects of the patient's tongue.

Graphic Jump Location

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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