History: 9yo BM presented with 2 weeks of rash and blisters on his left hand. He was hospitalized (ID service) and being treated with IV acyclovir and IV clindamycin.
Medications: none at home, IV acyclovir and clindamycin in the hospital.
Physical Exam: Erythematous, bullous lesion involving his palm, as well as 4th and 5th digits of the left hand, draining serous fluid (Figure 1).
Labs: CBC, CMP WNL; HSV PCR neg, VZV PCR neg, Bacterial wound culture: moderate coagulase negative staphylococcus.
1. XR hand: Soft tissue mass/irregularity, no definitive evidence of osteomyelitis.
2. MRI hand: No evidence of osteomyelitis, mild tenosynovitis involving the flexor tendons of the third and fourth digit, multiple superficial vesicles.
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