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[Clinical Picture] Tungiasis: diagnosis at a glance

A 22-year-old Japanese woman presented to our hospital with a 10-day history of pain and a rash on her right first toe 10 days after a 2-week trip to Uganda, where she had stayed within Manafwa district. Although she had worn shoes and socks during student fieldwork she reported wearing sandals with no socks around the suburban guesthouse. On examination she had a yellowish-white nodule, 5 mm diameter, with a central black spot at the rim of her right first toenail (figure). We suspected stage 3 tungiasis and excised the nodule under local anaesthesia, during which we saw several eggs (figure), and also gave a tetanus toxoid booster.