Diagnose this infant with an asymptomatic pearl-like nodule on the heel

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Can you diagnose this patient? Take our poll and find out! Then check back for the full case, differential diagnosis, and correct diagnosis.

Image 1

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Image 1

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Image 2

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Image 2

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Welcome to this Contemporary Pediatrics poll. Take a look at the following case below. After reading through the description, choose a multiple-choice answer and try to guess the correct patient diagnosis.

This case was presented by Giridhar Guntreddi, MD FAAP, FAPHM; Achuth Jayasankar Kondoor, Taylor Boske, Neelima P. Theella, MD, and Jayasree Vasudevannair, MD MPH FAAP.

The case:

A healthy 12-month-old girl presented with one small skin lesion over the right heel (Image 1) for one month. On examination, her right lateral heel showed a round, white, pearl-like, hard, tiny lesion with a smooth appearance without any redness or itching. The patient's mother denied any pain, swelling, itching or fever. No significant travel, bites, heel stick injuries were reported in the history. No systemic symptoms suggested any underlying systemic diseases. The infant is closely monitored at subsequent well visits and re-checked. After 3 months, the child showed full resolution of the skin lesion over the heel area (Image 2).

Below, take your best guess at diagnosing this patient.

What is the diagnosis of this case, based on the information provided?

Cutaneous mycetoma
Osteoma cutis
Scabies
Milia-like idiopathic calcinosis cutis

Now, click here for the full case presentation, differential diagnosis, and correct patient diagnosis.

Thank you for taking this Contemporary Pediatrics poll! Want more puzzler case studies? Click here.

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