Question of the Week # 232

232 )  A 32 year old man is evaluated in the clinic for an intensely itchy rash on his feet.  He denies any fever or  using any recent medications. He just returned yesterday from a pleasure trip to Philippines. While on vacation , he spent his time visiting historical sites, rivers and beaches. He does not swim but enjoys walking in the water near shore. On examination, there  are multiple papules on the plantar and dorsal aspect of the feet bilaterally. There are no vesicles or pustules. The skin above the level of calves is not involved. Which of the following is the most likely diagnosis?

A) Hot tub folliculitis

B) Vibrio Vulnificus

C) Cutaneous Larva Migrans

D) Swimmer’s itch

E) Strongyloidiasis

Question of the Week # 227

227 )  A 32 year old man is evaluated in the clinic for intensely itchy rash . The rash appeared suddenly on his trunk 24 hours ago  and has spread to his extremities. He denies any fever or  using any recent medications. His travel history is significant for a trip to Colarado 3 days ago where he stayed with his friend in a hotel room. He enjoyed camping in the mountains and spent his evenings in the hotel building’s swimming pool. On examination, there  are multiple red papules all over his body and extremities but not on the head and the neck. Some of the papules are tender. Which of the following is the most appropriate next step in management?

A) Doxycycline

B) Lyme Serology

C) Ciprofloxacin

D) Reassurance

E) Amoxicillin-Clavulunate

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