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March 1988

A Subungual Nodule of Recent Onset

Author Affiliations

University of Michigan Medical Center, Ann Arbor

Arch Dermatol. 1988;124(3):429-430. doi:10.1001/archderm.1988.01670030095030

REPORT OF A CASE  A 30-year-old physician walked barefoot on the sandy bank of the Carrao River in the Canaima National Park in Venezuela. Three days later, while returning to the United States, he noticed a painful white pea-sized papule on the tip of the second toe (Fig 1). No other lesions appeared. Microscopic features of the excised papule are seen in Fig 2.What is your diagnosis?A Subungual Nodule of Recent Onset

DIAGNOSIS:  Tungiasis.

DISCUSSION  The hematoxylin-eosin-stained section illustrates a transverse segment of a gravid female chigoe flea, Tunga penetrans.Tungiasis is usually acquired by walking barefoot in endemic areas. Although feet are most commonly involved, any cutaneous surface can be affected and squatting may result in infestation of the perineum and buttocks.1 The small adult fleas are only about 1 mm long and while both males and females burrow will seek a blood

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