Four infants had soft, skin-colored nodules in the midline plantar region of the heels since birth. The lesions were asymptomatic, bilateral, and symmetric, and measured approximately 1 cm in diameter. Their size increased in proportion to the growth of the child. In three infants the lesions persisted at 1 year of age, while in the fourth they remained at age 12 years. The nodules were not associated with any other disease or abnormality. A review of the literature revealed only one Argentinean series comprising four cases, and two communications at international pediatric congresses by French and American authors who reported five and three cases, respectively. We describe four additional cases of precalcaneal congenital fibrolipomatous hamartoma and comment on their histopathologic and ultrastructural characteristics.

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Case 1. A 33-year-old man was prescribed lansoprazole 30 mg/d for peptic esophagitis. He reported alcohol intake (50 g/d) but denied the use of any other medication or illicit drugs. His baseline liver function test values were normal. He was asymptomatic, and physical examination was unremarkable. Serum chemistry was suggestive of acute liver injury (Table 1); serology ruled out viral causes. Screening for autoantibodies was negative, and findings on abdominal ultrasonography were normal. Lansoprazole was withdrawn; hepatic parameters performed within 3 months were normal. Seven months later, the patient was inadvertently rechallenged, and alanine aminotransferase (ALT) values increased 2.5 times over the normal upper limit. Normalization was achieved after 3 months.Case 2. A 44-year-old man was treated with lansoprazole 30 mg/d and domperidone for peptic esophagitis and duodenitis. Twenty days later, he presented with a 1-week history of asthenia, weight loss, and pruritus. Two years earlier, when a cholecystectomy was performed, he had ALT levels of 47 units/L. He had no toxic habits and was taking no other drugs or herbal remedies. Laboratory results indicated cholestatic injury without evidence of viral causes (Table 1). Screening for autoantibodies was negative, and an abdominal ultrasonography showed no expanded bile ducts. Lansoprazole was withdrawn (but not domperidone) and laboratory findings returned to baseline at 26 days.

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