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MKSAP: 20-year-old male college student with a superficial skin infection

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 20-year-old male college student on the wrestling team is evaluated for a superficial skin infection. He has a history of several episodes of folliculitis and furunculosis over the past year that has required systemic treatment. His recurrent infections were treated with various oral antibiotics, including cephalexin, clindamycin, and trimethoprim-sulfamethoxazole. He currently takes no medications, has no drug allergies, and is otherwise in good health.

On physical examination, vital signs are normal. There are multiple, scattered erythematous papulopustules and nodules on the buttocks and upper thighs, some with a collarette of scale. He has no background erythema or lymphadenopathy. The remainder of the physical examination is unremarkable.

Which of the following is the most appropriate next step in management?

A. Culture a pustule
B. Perform a Tzanck smear
C. Start linezolid
D. Start vancomycin

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