Pruritic, painful callus on the toe

Presenter: Ashley Feneran, D.O., Sital Patel, D.O., Kevin Cooper, M.D.

Dermatology Program: University Hospitals Richmond Medical Center

Program Director: Jenifer Lloyd, D.O.

Submitted on: March 3, 2014

CHIEF COMPLAINT: A new-onset callus on the left third toe

CLINICAL HISTORY: 40-year-old Caucasian female with no significant past medical history who presents with a new-onset callus on the left third toe. Initially, the patient complained of pruritus and pain at the site which worsened over time. Eventually, the site drained purulent exudate. Three 7-day courses of levofloxacin 500mg daily prior to presenting to dermatology. Prior to the development of the lesion, the patient admits to traveling to Kenya to perform in rural outreach projects. A bone scan was negative for osteomyelitis.

PHYSICAL EXAM:
Examination revealed a well-appearing female with a pearl-like whitish papule with a central black dot. Several weeks later, the area was ulcerated with purulent exudate.

LABORATORY TESTS: N/A

DERMATOHISTOPATHOLOGY:

Microscopic examination of a shave biopsy of the left third toe reveals parakeratosis with basophilic material in addition to eosinophilic ribbons. There are also circular structures throughout.