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A Painful Furuncle-like Nodule on the Scalp
Fu-Sen Hsieh , J Yu-Yun Lee , Hui-peng Huang
Dermatol Sinica 22 : 197-198, 2004

Case report
A 40-year-old healthy male physician presented with a painful erythematous swollen nodule on the scalp for a two-week’s duration after returning from a trip to Peru. He didn’t recall any insect bite during the trip. Approximately one week after returning home he noticed a small papule with intermittent episodes of pain on the scalp. He thought that the lesion might be a folliculitis and topical antibiotic was applied. However, the lesion didn’t improve and progressed to a nodule with some bloody discharge. In addition, patient occasionally felt a sensation of slight movement within the lesion. His wife said that there seemed to be something emerging from the lesion. At the initial visit, the clinical diagnosis was furuncle or inflamed follicular cyst and oral and topical antibiotics were prescribed for 10 days without any clinical response. Incision and drainage was performed. During the procedure, a white moving tube-like process protruded out from the incision site. A whitish worm was gently extracted from the nodule. The patient was then referred to our department’s clinic for further evaluation. Examination of the scalp revealed a small crusted lesion on the scalp (Fig. 1). The worm had three rows of black, backward-pointing spines on the body (Fig. 2).

   
   
 
 
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