Intradermal moving tracks

Abstract

A 64-year-old female presented in August of 2022 to the infectious disease clinic for pruritic lesion and seeing worms on her left foot. Her medical history includes hyperlipidemia, seborrheic keratosis, actinic keratosis and basal cell carcinoma that was excised in 2020. In November 2021 she traveled to Jamaica, where she used to dance barefoot on the sand. Two months into her stay, her symptoms started with itchiness and burning sensation in her left foot. Moreover, when she got back to the U.S. in July 2022, she developed watery diarrhea that resolved on its own. She denies having any other systemic symptoms. She tried using natural oils and neem powder for the itch. Her symptoms persisted, and she ended up going to a primary care physician who prescribed one course of albendazole. After taking the first dose, her lips swelled, and she felt unwell hence she was referred to the infectious disease clinic. Further history showed that she is a cashier who lives on a farm in Columbia, Missouri. She has cows and a pet dog on her farm where she walks barefoot. Her vital signs were normal. On physical exam she had an erythematous creeping skin lesion with a serpiginous pattern on her left foot.