Rachel St. John, MD

Five weeks after returning from a school trip to the Amazon in Peru, a 16-year-old boy presentedwith 2 persistent “bug bites” on the lateral left calf. He had sustained multiple bug bites duringhis trip, all of which had resolved spontaneously except for the 2 on his lower leg.

An infected insect bite was initially diagnosed, and a course of oral trimethoprim/sulfamethoxazole was started. Eight days later, the patient returned with worsening symptoms and a "white thing poking in and out" of one of the lesions (A). He was advised to occlude the lesion with petroleum jelly and an adhesive bandage. The next day, the patient brought in the "creature" that had emerged from the lesion. It was subsequently identified as a larva of the human botfly, Dermatobia hominis. A second larva emerged from the other lesion 1 week later.

A 16-year-old girl presented with a painful rash on her hands and feet, and a sore throat. The rash, which "itched and burned," had appeared on her palms and soles a day earlier and had worsened overnight.