Fig 1.

Progression of clinical manifestations. Index finger lesion at presentation. A single tender vesiculopustular lesion on the left index finger was observed on day 9. The lesion was 6 millimeters in diameter, with no fluctuation or local heat on palpation (A); Needling of the left index finger lesion was performed on day 10, leading to hematoma development at the puncture site (B); On day 12, significant lymphangitis developed, extending up to the left axilla (C) associated with slight enlargement of the primary lesion (D), and appearance of 2 additional lesions on the fifth left toe (E) and middle back (F); During days 13-16, the aforementioned systemic and lymphangitic (G) manifestations subsided, while the primary lesion continued to enlarge up to 10 millimeters in diameter (H,I).