TWiP 261: A case for Dr. Hickam

TWiP solves the case of the pregnant woman from Tanzania with dehydration and 3 weeks of bloody stool, a situation that would confuse Ockam but not Dr. Hickam.

Hosts: Vincent Racaniello, Daniel Griffin, and Christina Naula

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New Case

I feel like the back section of our book has been a bit neglected. The new PD 8th Edition is posted on our website so please download a copy and extra points to anyone who can tell us what that is on the cover.

Three individuals are involved here with a rather impressive travel history. We have a mom, a daughter and a son who reach out for guidance. Initially one of them found something small dark and about the size of a poppy seed embedded in their skin. This led to a more involved investigation where they found that all three had similar findings but some of these were larger, some a bit larger, one was actually described as mobile. They all feel fine and report no skin rashes. They have a number of concerns about what these are, if they might carry disease, what to do about removing them and should there be testing or treatment. The interesting travel and exposure history. They report that just prior to this they spent a week on a remote island off the coast of Scotland with extensive hiking in tall grass and boggy areas with deer, rabbits, and lots of sheep. An Island called Harris and Lewis and then just that Saturday hiking in wooded areas around Loch Ness and in the Cairngorns. Sunday out hiking and running on Long Island and then Wednesday when these mystery objects were found they had just been hiking and going for a run in Cape Cod. They report on Cape Cod the trail they followed had a fallen tree and they had to crawl underneath it prompting this skin inspection.

-lots of questions here…

What might these be and how do we identify them? Is the travel history relevant? Are there any timing issues that impact what we do? Should we try to remove these and if so how? Any testing or treatment indicated?

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Music by Ronald Jenkees