Case presentation A previously healthy six-year-old boy presented with painful lesions on the scalp and right arm that had been present for one week. Clinical examination Three tender, erythematous nodules on the scalp and one on the right arm Progressive enlargement of nodules over several days No fever or associated systemic symptoms Initial evaluation and management Lesions were initially presumed to be bacterial abscesses Incision and drainage of one lesion yielded minimal purulent material Empiric clindamycin was started for presumed staphylococcal infection Hospital admission The patient was admitted for ongoing evaluation and treatment Multiple fluctuant “abscesses” were noted on examination Infectious disease consultation was obtained due to the absence of purulence Travel history investigation The patient and family had returned from a Caribbean cruise one week prior to symptom…