Tuesday, September 6, 2016

Case of the Week 412

The week's case was generously donated by Dr. Audrey Schuetz from Mayo Clinic and Dr. Roy King of Dermatopathology Partners.

The patient is a 70 year old woman with a painful lesion on the side of her foot. She also had a similar lesion on the tip of one of her toes. She had recently returned from Brazil, where she had been for 1 month. The lesions appeared approximately 2.5 weeks into her visit and were preceded by pruritus. She reports walking barefoot on the beaches while in Brazil.

 Below are H&E-stained sections of the curetted lesions:



Unknown said...


Unknown said...

If she was a surfer, I'd say "CowaTunga".

Emily Veltus said...

Tunga penetrans. Anyone interested in studying this parasite should visit refugee camps in western Tanzania... Hundreds of cases.

Anonymous said...

Tungiasis. Too bad the parasite is mushed up some. They are spectacular microscopically and so big!
BW in VT

Anonymous said...

The clinical history as well as geographic origin point toward Tunga penetrans. What we need here are the identification clues that will tie all the evidence together.

Florida Fan

SVMI said...

tungiasis (tunga penetrans)

Matthew Rollosson said...

I used to get those when I worked in Ethiopia. They itch like hell, but they didn't hurt. One of the women who worked at the clinic taught me how to remove them.

Washing my feet before bed solved the problem.

Anonymous said...

Hope it wasn't Leishmannia braziliensis.

Unknown said...

Certainly tunga penetrans. The history and presentation of the nodule (especially the conspicuous 'eyeball' appearance of the head of the nodule where the posterior can be seen) were a dead give-away.

The histo slides are pretty difficult to read though due to the fact that they are a bit of a mess, invertebrates can be a pain to section if you are not aware of what you are working with or are not well practised in their preparation. However, we can clearly see tracheae and a little of the striated muscle that one would expect in tunga sections. The structures in the top right of the forth picture could be mature ova, but it is hard to tell since they are damaged. I cannot pick out the hypodermal layer for sure, but if some of the larger, more amorphous structures are exoskeleton, then the lighter stained cell structures directly subsurface to them is likely to be just this.

I am not all that well versed in tunga histo, however, so I would welcome observational notes from a Parasitologist more seasoned in this field!

Apu Mridha said...

Thank you for sharing such an amazing and informative post. Really enjoyed reading it. :)


Medical Case Management