Bugs in the Ear Lobe

A recent case from our clinic has raised a lot of interest among members of the International Society of Travel Medicine.  We present it here for the benefit of interested medical professionals.  As you will see, the case remains under investigation to determine exactly what the lesion is.

The story is as follows:

The patient is a 65-year old university professor who spent a week on vacation at a jungle lodge along the Amazon River.  While there, she recalls being bitten by a number of insects.  Perhaps of significance is the fact that the resident cat from the lodge often slept on her pillow.  She was not ill while on the trip.

After returning home, she noticed that over the course of several days one of the insect bites on her right ear lobe was gradually becoming larger, red and more itchy and painful.  Also, she was developing some tender adenopathy of the neck inferior to the ear lobe.

Examination two weeks after her return showed a moderately tender, mildly red, nodular lesion of the right ear lobe, measuring 1.5 x 2 cm and with a 2 mm central. black "pore".  There was a single, mildly tender, 2-3 cm anterior cervical lymph node palpable inferior to the ear lobe.  The remainder of the exam was normal.  (Unfortunately, photographs could not be taken at this visit.)

As it was suspected that this represented either tungiasis or myiasis, she was instructed to keep the ear lobe covered with an occlusive layer of petroleum jelly while consultation was sought with other Travel Medicine specialists.  A few hours after applying the petroleum jelly, she felt movement in the lesion and, looking in the mirror, found "something poking its head out."  With the help of a friend, the pore over the lesion was enlarged and the "something" removed.  The first three of these items were discarded but, after being asked to do so, she brought the fourth in for evaluation.

Having extracted these animals, she is now feeling much better.  The ear lobe is almost back to normal size and color although a small nodule remains, and the lymphadenopathy has resolved. 

As she is up to date on immunizations and has shown no signs of bacterial superinfection, no further treatment has been initiated other than to keep the area covered with an antibiotic ointment.  The insect that she submitted has been examined microscopically and the photos are being distributed to entomologists for identification.  If the ear lesion does not totally resolve in a reasonable time, we will consider surgical excision.

Post-extrusion photographs of the lesion and two photos of the "bug" (dorsal and ventral) are included here.

I. Dale Carroll, MD, FACOG, DTM&H

Medical Director