Phone Visit
Narrative: SPRUCE MESSAGE VISIT Date: 2026-06-03 Encounter: Spruce text message with photo review CC: Clustered dots/rash behind the knee and scattered on the body after a trip to Florida. HPI: Thomas is approximately 17 months old and developed a rash with clustered dots behind his knee and scattered lesions elsewhere on his body after returning from Florida the prior weekend. The parent noted he was briefly warm upon waking from a nap the day before the rash was noticed but did not take a temperature and he otherwise appeared well. He had been sitting in sand during the trip and other family members had complained of bugs at an outdoor dinner. On follow-up the next day, new dots were noted around the diaper area, on the fingers, chin, and cheek, raising concern for a viral etiology in addition to the initial bug bite hypothesis. Assessment: Initially assessed as insect bites given Florida travel history, sand exposure, and known bug complaints during the trip. On follow-up the next day, the distribution of new lesions on the fingers, face, and diaper area prompted reconsideration, with Dr. Hobbs raising hand, foot, and mouth disease (HFM) as an alternative diagnosis. No oral blisters were noted by the parent and Thomas had no other symptoms beyond transient warmth and crying when the spots were touched. Plan: Steroid cream recommended for the initial rash presumed to be bug bites. On follow-up, parent was counseled on additional HFM symptoms to monitor (pain, change in stools) and advised to continue observation and follow up with questions. No prescription was sent. Medications: - Steroid cream Topical, applied to rash lesions (new) Key clinical quotes: "I'm pretty sure it's bites :) I'd put some steroid cream on them, I bet they itch a good amount" "curious - it does make me think of hand/foot and mouth a little" "Pain, change in stools, sometimes just the rash" Source: Spruce conversation t_2GDBR8BFPUO00