In order to confirm the diagnosis, and as fungal cultures were not available in Laos, identification by PCR was attempted at Tübingen from heated and ethanol-treated tissue. Leech bites skin#Due to the pathognomonic microscopic findings of sclerotic cells he was diagnosed with chromoblastomycosis and started on itraconazole 400 mg/d monthly pulse therapy on day 18 and a surgical debridement of all skin lesions was performed on day 21.Īdditional file 1: Videoclip showing perpendicular scraping movements of maggots in the patient's very tender heel that initially were overlooked. During wound dressing on day 3, 22 maggots (fly larvae) were discovered in the heel wound (Figure 5, Additional file 1) and identified as third instar larvae of the Old World screwworm fly, Chrysomya bezziana (Diptera: Calliphoridae). Bacterial culture of wound discharge grew Escherichia coli susceptible to co-trimoxazole by disc diffusion testing (according to CLSI guidelines ). He was treated with oral cloxacillin and metronidazole for 1 week, followed by co-trimoxazole, and local iodine-based antiseptics. Left lower leg and foot radiographs showed no evidence of bone involvement. He was thought initially to have leprosy or skin cancer, but skin scrapings from the left lower leg lesions revealed typical brownish, round, thick-walled, multiseptate sclerotic cells in a wet film, confirmed with the 10% potassium hydroxide technique (Figure 3 and 4).
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