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A 4-year old boy is brought in because of marked edema and pruritis of his penis and foreskin. His family is visiting on vacation and staying at a rental home. He spent most of the prior day playing outside, and he has several papules consistent with bug bites on his arms, legs, and back. He is afebrile and there is no redness or warmth to the edema. He is uncircumcised, and there is no tight constricting band noted. 

What is the most likely cause of his symptoms?
9 votes