Multiple Bites From the Larvae of Haemaphysalis longicornis

Figure 1. Tick bites and ticks seen on the study patient. A, Multiple erythematous papules observed on the lower abdomen; the inset shows a tiny brown organism observed at the center of an individual papule. B, In the larva of Haemaphysalis longicornis, the capitulum has a short corn-shaped hypostome; the scutum, anus, and festoon are also seen. Coxa I has a broad triangular spur; coxae II and III have a slightly elevated ridge in place of the spur. The asterisks indicate the coxae, or points of joint attachment of the legs to the body. The arrow indicates the hypostome, showing a 2/2 dental formula describing the arrangement of toothlike bumps.

Figure 2. The biopsy specimen shows that the larva penetrated the epidermis and consumed red blood cells. There was no cavity formation or remaining mouth part in the dermis. The infiltrated cells in the upper dermis were mostly eosinophils and extravasated red blood cells (hematoxylin-eosin, original magnification ×200).