SHM Converge Scientific Abstract ePoster Gallery-Don't Monkey Around With Rashes

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A 63-year-old man presented with a pustular rash on his right hand, swelling of the distal right arm, and scattered lesions on the abdomen and flanks, prompting concern for mpox. He had no sick contacts, pets, new medications, or substance use, and was not sexually active. Exam showed monomorphic pinpoint pustules on the dorsal right hand and trunk, with normal vital signs and labs.<br /><br />An infectious disease workup was negative for herpes simplex/zoster, HIV, syphilis, scabies, and orthopoxvirus (mpox). Pustule cultures grew normal skin flora. A punch biopsy showed epidermal ulceration with abundant eosinophils and no viral cytopathic changes, supporting arthropod assault rather than viral infection.<br /><br />The key diagnostic clue came from a careful history and environmental investigation. Ants collected from the patient’s front porch—almost certainly red imported fire ants (Solenopsis invicta)—were identified as the likely cause. Fire ant “bites” are actually venomous stings, and their pustular skin lesions can closely mimic mpox, but they typically do not produce a systemic illness.<br /><br />This case highlights the importance of broad differential diagnosis, detailed history-taking, and collaboration among hospitalists, infectious disease specialists, dermatologists, pathologists, and even an amateur myrmecologist. It emphasizes that clinicians should consider common environmental exposures, not just emerging zoonotic infections, when evaluating unusual rashes.

Asset Subtitle

Noel Ivey

Meta Tag

Author List Gary Cox, Jason Stout, Mark W. Chandler, Noel Ivey, Oskar Kraus

Category Clinical Vignettes

Concept Mpox

Concept Pustular Rash

Concept Arthropod Assault

Concept Fire Ant Stings

Concept Differential Diagnosis

Distinguished Non-Finalist

Presenter Organization Duke University Hospital

Presenting Author Noel Ivey

Track Adult

Keywords

mpox

pustular rash

fire ant sting

Solenopsis invicta

arthropod assault

eosinophils

skin biopsy

differential diagnosis

infectious disease workup

environmental exposure

Mpox

Pustular Rash

Arthropod Assault

Fire Ant Stings

Differential Diagnosis