A 52-year-old woman was concerned about the recent appearance of multiple itchy papules on her feet and lower legs. Her husband was experiencing the same phenomenon. While old lesions readily resolved following application of a mid-potency topical steroid, new lesions were appearing every morning. The patient brought in some “bugs” wrapped in a bandana, and wondered whether they might be responsible.
Key point: The vast majority of the time, when a patient brings in “bugs” suspected to be responsible for cutaneous signs or symptoms, they are merely presenting debris. Such patients may suffer from delusions of parasitic infestation. However, it is always wise to give the patient the benefit of the doubt and examine their “specimens.” In this case, the easily visible 5mm-long insect, is a classic bedbug (Cimex lectularis). This picture is taken through the eyepiece of the office microscope.
Treatment: Bedbug infestations may be difficult to eradicate. Consultation with a professional exterminator is advisable.
Note: Bedbugs are nocturnal blood feeders, which is why new lesions kept appearing in the morning.
A hematologically stable CML patient developed a solitary, exquisitely painful ulceration, 7 cm × 5 cm, located on the mid-medial foreleg. There was never any evidence of venous insufficiency. The patient denied the possibility of a spider bite. What is the likely cause of this lesion?
