Case #275 – May, 2010
A 70-year-old female, who had recently returned from a trip to Madagascar, went to the hospital for a painful sensation on the underside of her left foot while walking. Examination of the area between the hallux and index toes revealed an ulcerative lesion. A biopsy was performed and sent to the Pathology Department for work-up. The specimen was sectioned, stained with hematoxylin and eosin (H&E) and examined by the attending pathologist. Figures A and B show what was observed at 40x magnification. Figures C and D show the same fields at 200x magnification, respectively. What is your diagnosis? Based on what criteria?
This was a case of tungiasis caused by the chigoe flea, Tunga penetrans. Diagnostic features included:
- location of the parasite between the toes.
- remnants of a sclerotized, chitinous exoskeleton (CU, Figure C).
- remnants of the trachea (TR, Figure C).
- developing eggs (EG, Figure D).
More on: Tungiasis
Images presented in the DPDx case studies are from specimens submitted for diagnosis or archiving. On rare occasions, clinical histories given may be partly fictitious.
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