A 74-YEAR-OLD WOMAN presented with a 3-day history of an intensely pruritic rash that was localized to her upper arms, upper chest between her breasts, and upper back. The pruritus was much worse at night while the patient was in bed. Symptoms did not improve with over-the-counter topical corticosteroids.
The patient had a history of atrial fibrillation (for which she was receiving chronic anticoagulation therapy), hypertension, an implanted pacemaker, depression, and Parkinson disease. Her medications included carbidopa-levodopa, fluoxetine, hydrochlorothiazide, metoprolol tartrate, naproxen, and warfarin. She had no known allergies. She reported that she was a nonsmoker and drank 1 glass of wine per week.
There were no recent changes in soaps, detergents, lotions, or makeup, nor did the patient have any bug bites or plant exposure. She shared a home with her spouse and several pets: a dog, a cat, and a Bantam-breed chicken. The patient’s husband, who slept in a different bedroom, had no rash. Recently, the cat had been bringing its captured prey of rabbits into the home.
Review of systems was negative for fever, chills, shortness of breath, cough, throat swelling, and rhinorrhea. Physical examination revealed red/pink macules and papules scattered over the upper arms (FIGURE 1), chest, and upper back. Many lesions were excoriated but had no active bleeding or vesicles. Under dermatoscope, no burrowing was found; however, a small (< 1 mm) creature was seen moving rapidly across the skin surface. The physician (CTW) captured and isolated the creature using a sterile lab cup.
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