Tungiasis in the United States: a travel souvenir.

Tungiasis is a cutaneous infestation caused by the burrowing flea, Tunga penetrans. This infection typically results in the development of one or more wart-like fibrous papulonodules. The causative flea is endogenous to Central and South America, sub-Sarahan Africa and portions of India; consequently, tungiasis is rarely reported in North America. However, because of increasing air travel to and from endemic areas due to business and pleasure, it is imperative that this entity remain in the differential diagnosis when evaluating clinically suggestive lesions in a patient who also has a history of recent travel. We report a case of tungiasis in a 24-year-old Caucasian woman who presented with 7-week history of a non-healing, eroded nodule on the medial aspect of her left great toe. Significant history included travel to Tanzania during three months immediately prior to presentation. Following the presumptive clinical diagnosis of tungiasis, surgical removal of the flea and its contents was performed and the base of the lesion was curetted, without complication. The specimen was sent for histopathologic correlation which confirmed the diagnosis.