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Corresponding author: James H. Diaz, MD, DrPH, Professor of Public Health and Preventive Medicine, School of Public Health, Louisiana State University Health, New Orleans, LA
A 21-y-old man was hiking the length of the Appalachian Trail (AT) from its southern
terminus at Springer Mountain, Georgia, to its northern terminus at Mount Katahdin,
Maine, during the summer after college graduation. By the time he reached the North
Carolina section of the AT, he had developed an intensely pruritic, papulovesicular
rash with draining pustules confined to a circumferential area around his waist and
hips covered by his underwear (Figure 1). He had hiked sections of the AT before as a summer camp counselor and sustained
scratches and insect bites while on the trail but had never developed such an extensive
and pruritic regional skin eruption. He could no longer continue his trek. He called
his sister, who lived in Asheville, North Carolina, on his cell phone, requesting
a ride to the nearest urgent care facility.
Figure 2A 6-legged larva of a trombiculid species mite (family Trombiculidae) capable of causing
chiggers worldwide. The feathery anterior projection is the mite’s feeding stylostome,
which is usually retracted unless feeding. Source: Wikimedia Commons. Photo by Alan
R. Walker. Public domain, no copyright permission required. Available at: commons.wikimedia.org/wiki/File.Trombicula-mite-larva-with-stylostome-2.jpg.
