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August 1995

Inflammatory Papules on the Back of a Traveling Businessman

Author Affiliations

Wayne State University School of Medicine, Detroit, Mich

Arch Dermatol. 1995;131(8):951-952. doi:10.1001/archderm.1995.01690200089017

REPORT OF A CASE  A 45-year-old white businessman, who frequently travels to western Africa, presented 1 day after returning from a recent trip to Sierra Leone. Pruritic clusters of follicular inflammation developed on his back 1 day before his departure from that country. Physical examination revealed multiple, 4- to 8-mm clustered, erythematous, crusted papules on his midback, primarily on the right (Figure 1). An initial diagnosis of folliculitis (vs herpes zoster) was made. Cephalexin for folliculitis was given.Six days later, on awakening, several small, black, wormlike organisms were found crawling on his side of the bed. He returned to us that day and about 20 larvae were removed from his back (Figure 2). Laboratory tests showed only slight eosinophilia (0.03). The patient responded well to treatment.What is your diagnosis?Figure 1.Figure 2.

DIAGNOSIS:  Tumbu fly myiasis.

HISTOPATHOLOGIC FINDINGS  The larva submitted (diameter, 12×6×6 mm) was a mature