A Child with Lumps and Bumps Down on the Farm

A 21-month-old Caucasian female with a history of eczema was referred to the pediatric surgery clinic for evaluation of bilateral axillary and right inguinal lesions of four months’ duration. The lesions varied from 0.5 cm to 1 cm in diameter and were red in colour, fluctuant and nontender (Figures 1 and 2). There had been no response to oral antibiotics, and the left axillary lesion had been spontaneously draining pus (Figure 2). The child remained well and active, with no history of fever, night sweats, weight loss or cough. She had sustained a hamster bite to one of her fingers a few weeks before the appearance of these lesions. Her family operated a potato farm that had dogs and cats but no large farm animals. There was no history of travel or exposure to tuberculosis. The remainder of the physical examination was unremarkable, and her complete blood cell count and serum immunoglobulin levels were normal. What is the diagnosis?