PCP Case Challenge: Lesions on the Hands, Palms, and Feet of a 57-Year-Old Man

Lars Grimm, MD


April 20, 2022

Editor's Note:
The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.


A 57-year-old man with a history of type 2 diabetes mellitus and hypertension presents with a 2-week history of vesiculobullous lesions on his feet and hands. The lesions first appeared on both of his feet and have been increasing in size and number; over the past several days, they have begun to develop on both of his palms and on the sides of the fingers. The patient was seen at a different clinic approximately 1 week ago and was given an ointment to treat the lesions; this has not resulted in any improvement. The lesions are extremely pruritic.

The patient has not had any recent travel history, and he lives alone, without any pets, in a regularly cleaned apartment. He has had no discernible new exposures and has not experienced any fevers or constitutional symptoms. The patient is on insulin, labetalol, and a combination pill of lisinopril/hydrochlorothiazide plus omeprazole; he has been on these medications for a long time and has had no prior complications. The patient has no known allergies.


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