Extract

A 29-year-old Spanish woman with no significant medical history presented to our Department of Tropical Medicine with burning erythematous plaques and pustular skin lesions on her right arm following a recent trip to Thailand from 16 June to 26 June 2024. The onset of symptoms occurred on 24 June, 8 days into her travels, coinciding with her stay in Chiang Mai. On that same day, the patient participated in an excursion to an elephant sanctuary on the outskirts of the city, after which she returned to Chiang Mai for the night. Physical examination at our clinic on 1 July revealed crusted lesions on an erythematous plaque on the right biceps and forearm, displaying a distribution pattern consistent with ‘kissing lesions’ (Figures 1 and 2). The patient also reported the appearance of a second lesion several days after the first; following her return to Spain, a bullous lesion ~3 cm in length with an erythematous base developed on the wrist (Figure 3). The patient did not recall any specific contact with substances or organisms that could have precipitated the rash. When shown an image of the likely arthropod responsible for her condition, as per our initial suspected diagnosis, the patient did not recognize it.

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