A 62 y.o. white male developed a painful draining lump on the vertex of his scalp after vacationing in Belize in the winter of 2007-2008.

He and his wife, ecotourists, spent thirteen days in Belize. The first four days were spent on barrier islands off the coast, and the last nine days were spent at a "jungle lodge" in the humid coastal lowlands. While on the islands they engaged in snorkeling and in the coastal lowlands they explored the jungle flora and fauna.

The patient was unaware of any injury he sustained related to contact with coral or marine creatures. Mosquito netting was used at night in both locations, and insect repellents were used during the days. He wore a hat when outside in the jungle. He recalled no insect bites when he was on the islands. He was aware of being bitten by insects on his wrists and his ankles while exploring the jungle although he never saw the biting insects. He waded up to his knees in a fresh water stream, ate food prepared by local lodge keepers, and drank water from a mountain spring that he was assured was safe. Prior to travel he had received appropriate immunizations, and he took chloroquine prophylaxis for malaria.

He first noticed the then slightly painful bump on his scalp about ten days after his return from Belize. It progressively enlarged, was episodically more painful, and began to drain. He eventually sought attention from his primary physician who manipulated the scalp lesion with a needle which seemed to make it more painful. Ultimately he was referred to a surgeon who incised and explored the lesion.

Before surgical incision the patient's sore would have appeared similar to one of those pictured at left.