I am a 48 year-old female radiologist in excellent health. I am taking no 
medications and have no history of allergy. I stayed in a rainforest lodge 
in  Costa Rica (near the Panamanian border) about five weeks ago. There was 
no hot  water in the lodge to wash clothes or bedding. Several hours after 
arriving at the lodge, I noticed red, pimple-like eruptions (resembling 
bites) distributed primarily around my ankles and lower legs with a few 
lesions in the inguinal regions bilaterally. These were intensely pruritic. 
I did not treat them with any medication and traveled back to the States, 
where the lesions persisted. They became somewhat nodular and were intensely 
pruritic, especially at night. On numerous occasions, I noted the appearance 
of numerous, small hives especially posterior to the knee and in the upper 
inner  thigh regions bilaterally. These seemed to disappear by morning. Ten 
days ago,I had the yellow fever immunization (I plan to travel to Brazil in 
the near future) and a tetanus booster. I had no immediate allergic reaction 
to these injections. At the same time (ten days ago), I began treating the 
skin lesions (which I presumed to be scabies) with 1% Lindane lotion. I did 
not do  a total body application. Rather, I applied the lotion liberally to 
the lesions on about 4 occasions over a 3 day period of time. The lesions 
have responded dramatically to this treatment and have almost disappeared at 
this time. However, over the past 5 days I have experienced numerous areas 
of urticarial wheals (which come and go at inconstant intervals in a matter 
of hours) and on one occasion I lost my voice, indicative of mild laryngeal 
edema. I have not experienced wheezing. I am puzzled by the urticaria since 
I  was experiencing it prior to the yellow fever and tetanus injections.(It 
is  much worse since these injections, however.) Is it unusual to experience 
numerous areas of urticarial wheals after the lesions of scabies (or other 
mite infestation) have resolved? Do you know of any information that might 
be helpful to me in terms of treating (and understanding) this rather 
complicated medical scenario? 
 
Thank you very much for any information that you might be able to provide. 
(You realize, of course, that radiologists have very little knowledge of the 
skin! We deal only with its radiologically visible contents!)

Jeanne Bullock, MD

========================= 
From: Haines Ely <hpely@ucdavis.edu>

Dr. Bullock you have chigger bites. These are most common in the rain 
forest.  Expect 3 weeks of itch. Next time spray your ankles and socks with 
DEET, never sit down without something under you (take a poncho or small 
tarp to sit on) and spray the tarp with DEET daily.

Haines Ely 

=================
From: bberman@mednet.med.miami.edu

I spoke with David Taplin who is quite familiar with that area.  He feels : 
Fleas, chiggers, Cuticoides or sand flies.  Minor concern for developing 
Leishmaniais as well.  I wonder if she is allergic to eggs whose antigens 
are present in the yellow fever vaccine.

Brian Berman