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

Lars Grimm, MD


April 20, 2022

Physical Examination and Workup

Upon physical examination, the patient is well-appearing at rest, without any signs of undue anxiety or discomfort. His vital signs show a temperature of 98.7ºF (37.1ºC), blood pressure of 130/85 mm Hg, heart rate of 70 beats/min, respiratory rate of 18 breaths/min, and oxygen saturation of 98% while breathing room air.

Fluid-filled vesicles ranging in size from 1 mm to 3 cm are present on the instep and plantar aspects of his feet (Figures 1 and 2). The vesicles are present on the palms of his hands and the sides of the fingers as well. The lesions are all skin-colored, without any surrounding erythema.

Figure 1.

Figure 2.

No other lesions are found anywhere else on the patient's body. The lesions are nontender to palpation; additionally, his legs exhibit nonpitting edema up to the knees and reduced sensation to light touch, both long-standing conditions. The oropharynx is clear of any lesions, and the rest of the physical examination is unremarkable.


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