Rash in an eight-year-old boy.

Volume 86, Number 12 www.aafp.org/afp American Family Physician 1141 An eight-year-old boy presented with blisters on his lower lip and tongue that had appeared two days earlier. One day after the blisters appeared, a nonpruritic, bilateral rash developed on his palms and soles. The patient recently had swum at a community pool, after which he reported fatigue. He had no fever, chills, nausea, vomiting, rhinorrhea, cough, or history of recent travel. His activity levels and appetite were normal. The patient’s immunizations were up to date, and he had no significant medical history. Physical examination demonstrated erythematous, 2-mm ulcers in the oral mucosa of his lower lip (Figure 1), an erythematous pharynx, and tender vesicles on the hard palate and tongue. The skin examination revealed erythematous papules and vesicles with a surrounding rim of erythema on both of the palms and soles (Figures 2 and 3).