A 63-year-old man presents with a severely pruritic rash on both legs of 4 day’s duration. The intense pruritus and papulovesicular rash appeared approximately 2-3 hours after he had spent an hour walking through a grassy field alongside a lake. He has no other symptoms.
Examination reveals a bilateral papulovesicular eruption on both lower legs and ankles (Figure; click to enlarge) and a few papular spots below his waist.
To what diagnosis do the history and physical examination findings point?
A. Allergic contact dermatitis
B. Bullous pemphigoid
C. Chigger bites
D. Henoch-Schönlein Purpura (HSP)
Please click below for answer and discussion.
1. Riemann H, High WA. Chigger Bites. Uptodate.
2. Eliston DM. What's eating you? Chiggers. Cutis. 2006;77:350-352.
3. Gasser R. Wyniger R. Distribution and control of Trombiculidae with special reference to Trombicula autumnalis. Acta Trop. 1955;12:308.
4. Jones JG. Chiggers. Am Fam Phys. 1987;36:149.
5. Hase T, Roberts LW, Hildebrandt PK, Cavanaugh DC. Stylostome formation by Leptotrombidium mites Acari: Trombiculidae. J Parasitol. 1978;64:712.
6. Smith GA, Sharma V, Knapp JF, Shields BJ. The summer penile syndrome: seasonal acute hypersensitivity reaction caused by chigger bites on the penis. Pediatr Emerg Care. 1998;14(2):116-118.