She reported that the nodule first appeared during her trip as a small papule that increased in size over time and became painful. She had recently returned from travel in Uganda, where she had hand washed her clothing and hung them to dry.

Shared Decision Making and CommunicationĪ woman in her 30s presented to the dermatologist with a 3-week history of a painful nodule on her right inner thigh.

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The botfly Dermatobia hominis is the cause of a similar clinical manifestation in Central and South America. In endemic regions it is recommended that skin contact with the ground be avoided and washing be hung up to dry indoors.

Extraction and local antiseptic treatment usually achieve rapid healing. Mature larvae can be squeezed out or removed with tweezers. Infection is by direct skin contact with sandy soil or with clothing that has been put on the ground to dry and had eggs laid on it. A ”maggot-like” structure was found and identified as the third larval stage of the mango fly ( Cordylobia anthropophaga) ( Figure 1b), which is thought to be the principal cause of furuncular myiasis in sub-Saharan Africa. We noted two firm, elastic, furuncular subcutaneous swellings, 1 to 2 cm in diameter, each with a central opening and partly drained after treatmen t by a primary care physician ( Figure 1a). He had often gone around with his upper body unclad and had put his washing out to dry close to vegetation. He reported noticing a “crawling sensation” around his shoulder blades during the last few days of his stay. A 67-year-old man presented with subcutaneous swellings on his back after returning from a 3-week holiday in Senegal.

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