• Gianluca Nazzaro, Giovanni Genovese, and Stefano Veraldi.
• Department of Pathophysiology and Transplantation, Università degli Studi di Milano, I.R.C.C.S. Foundation, Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
• J. Cutan. Pathol. 2019 Apr 1; 46 (4): 251-255.

BackgroundTungiasis is an infestation caused by the penetration into the skin of the flea Tunga penetrans. Histopathologic studies on imported tungiasis are rare and based on a limited number of cases.MethodsWe carried out a review of 39 biopsy specimens collected from 39 patients with imported tungiasis. In all patients, ethnicity, gender, age, location, and clinical features of the lesions, Fortaleza classification and countries of infestation were recorded.ResultsHistopathologic study revealed hyper- parakeratosis and acanthosis. Fragments of the flea were located in the epidermis and upper dermis and were circumscribed by a pseudo-cystic cavity. Inside this cavity, we observed: the exoskeleton, made up of a thickened and eosinophilic cuticle; the striated muscle; the tracheal rings and the digestive organs (observed only in some specimens); the ovaries, very rich in eggs, and an inflammatory infiltrate, made up of lymphocytes and neutrophils, with numerous eosinophils. The hypodermic layer was never observed.ConclusionHistopathologic examination is helpful for the correct diagnosis of tungiasis in travelers returning from tropical and subtropical countries in which the infestation may be characterized by an atypical clinical presentation.© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

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