Infectious Diseases Case of the Month
Subcutaneous Nodule

A 17 y.o. hispanic male was seen at Wenatchee Valley Clinic (Wenatchee, WA where WM used to work) at the request of his primary physician because of a subcutaneous parasitic infection.

Born near Acapulco, Mexico the patient had moved to Chelan, Washington (North Central Washington) with this family when he was 12 years old. He was in good health and was a high school student. He liked to swim in Lake Chelan, a large mountain lake, and occasionally the Columbia River. His family had dogs when they lived in Mexico but not during their five year residence in Washington State. He liked seafood and occasionally his family would butcher a pig for their own consumption. He had not traveled out of North America.

His primary physician had excised a small (2-3 cm) subcutaneous lump from his left anterior chest that had developed spontaneously and asymptomatically a couple weeks previously. The patient felt well. A photomicrograph of the excised cystic structure is at left.

Click on the image for a close up view of the anterior portion off the parasite.

What organism is most likely to have caused the development of this subcutaneous cyst?
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Which organism was the most likely present in the cyst?

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