This is a case of a non-parasitic fiber that had been transcutaneously implanted and migrated under the skin due to physical pressure (i.e. walking). Although the presentation was suggestive of a cutaneous parasitic infection such as cutaneous larva migrans (CLM), the length of the object and dark color were not consistent with any human or zoonotic parasite. Several readers pointed out specifically that the larvae that cause CLM are microscopic and therefore would not be visible to the naked eye. Also, the path formed by a migrating worm would be more serpiginous rather than the semi-lunar pattern observed here. Other subcutaneous or intra-epidermal/dermal worms such as Loa loa, zoonotic microfilariae, and Dracunculus medinensis were also suggested but rightly discarded by readers because of the size and color of this object. There is no parasite, to my knowledge, that would have this appearance and be present in this location in human skin.
One intriguing suggestion was that this was cutaneous pili migrans (CPM) - an excellent thought. CPM is a phenomenon in which a hair grows within the skin rather than up and out of the skin, and is seen as long dark object just below the skin's surface. This is most common on hair-bearing regions of the body and would be unusual on the sole of the foot. However, removal of the object would be required to rule out CPM. Therefore, this is exactly what we did. Here are photographs of the object that we removed (cut in half):
Thanks again to Emily Hall for donating this fascinating case!
13 comments:
I guess there should be a name for the condition. I vote Cutaneous filum migrans. Thanks for the great case.
Very interesting case, it kind of reminded me of delusional parasitosis. Thank you for your work!
I was close enough
In speaking with my dermatology colleagues, I've found out that there is such a thing as "Teddy bear granuloma". With this phenomenon, fibers from a stuffed toy are accidentally inoculated into the skin of a child, much the way the fiber in this case is. Interesting!
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So, Dr. Pritt, you're basically saying that this fiber from clothing or a household object lodged itself into the baby's foot--and then it slowly got completely stuck within the foot? Or did it lodge itself in the baby's body somewhere else and then slowly make its way DOWN to the foot? Either way, how often does something like that happen? And could a tiny fiber like that harm a person? Thanks and love your case studies, Gina.
Good question Gina. From our understanding, the object penetrated the skin of the foot, much like a splinter would. Because it was so slender and was on the ball of the foot, we believe in migrated in a semilunar pattern due to pressure from walking. Make sense?
Morgellons ?
http://www.morgellons-research.com/
Morgellons fibers. There are thousands if not millions of people some of whom don't realise they are infected,depending on a few pioneers in your field to pull out a microscope, have any accepting spirit and take an unbiased inventory of symptoms, no matter how unusual they present. Remember this day that I say to you "Morgellons" is on the cusp of becoming an epidemic,we wait in limbo that the medical community gets on board this somatic condition as BIZARRE (AND I EMPHASIZE BIZARRE) as it seems. I have an understanding of a small portion of this co-infecting riddle I believe but the world needs a voice like yours. I've shifted my focus to treatment rather than a source, a cause or any of it to make sense as my family of 6 can only depend on me for care and reprieve and its a heavy load. Boyfriend, children ages 1,4,6 & 15 yrs and myself. I'm praying for a hero. I think this tops every other experience or grief I've walked through,short of one experience tray in hindsight doesn't hold a candle to today. I don't speak in forums or belong to any"communities", i also don't go to the doctor for every runny nose or bump on the head,i keep our antibiotic use to a minimum i believe in clean nutrition and detox for prevention and overall health,but for some reason I felt called to post here. Blessings.
Thank you for this post! My 11-year-old daughter had what we thought was a hair splinter in the sole of her foot yesterday, but I failed to remove it. When I went to try again today, I was disturbed to find that it had migrated along a curved path. Your post reassured me that it was not a parasite, and we successfully removed it!
Thank you for the note Jamie. I'm glad you found this posting to be helpful!
I Really wish people would stop chalking every complaint and Actual Parasitic Infection, up to Parasitic Psychosis, which Isn't the Real problem. Jumping to conclusions from a single O&P test, a normal eosinophil count (which can be 0, if the patient is taking antihistamines for itchng and other immune reactions).
AND BTW
TRAVEL HISTORY L, SCHMAZEL HISTORY
Air travel, food import, immigration, climate change, animal importation, shipping containers releasing Nutria and insects, sems carrying everything from ports across the country. Wake Up.
The REAL problem is physicians have become revolving doors instead of diagnosticians. Shortened times with patients, never reviewing OR Comparing lab results or even providing enough time to Hear the patient and develop a cogent care plan moving forward Anppd overbooking,filling the coffers, and too lazy to keep up with their jounals so they fail back into the old recliner,
Well said !!!
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