A 45-year-old laborer sought medical advice for a "fungous" infection which had involved the plantar aspects of both feet for several weeks (Figure). Initial treatment with topical fungicides had accomplished nothing after a week of use. A microscopic examination of scales with potassium hydroxide was negative for fungal hyphae, but this test may have been rendered invalid by previous treatment with antifungal preparations. Samples of his footwear were applied to his back as patch tests when an allergic contact dermatitis was suspected. The results to these tests were negative. In addition, primary irritant contact dermatitis was excluded by his history. He had been given no drugs within the last six weeks.
For several weeks the patient had felt listless with a constant dull headache which he attributed to the "flu." The examining physician noted enlargement of the cervical, axillary, and inguinal lymph nodes, an enlarged, slightly tender liver, and a